Healthcare Provider Details

I. General information

NPI: 1730830738
Provider Name (Legal Business Name): FREDERICK HEALTH AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 NORTH PL
FREDERICK MD
21701-6200
US

IV. Provider business mailing address

1050 CHINOE RD STE 350
LEXINGTON KY
40502-6571
US

V. Phone/Fax

Practice location:
  • Phone: 301-695-6618
  • Fax:
Mailing address:
  • Phone: 859-255-0075
  • Fax: 859-281-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRENDA CAMPBELL
Title or Position: AR BILLING MANGER
Credential:
Phone: 859-255-0075