Healthcare Provider Details

I. General information

NPI: 1588183503
Provider Name (Legal Business Name): FROSTBURG SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KAYLOR CIR
FROSTBURG MD
21532-2009
US

IV. Provider business mailing address

709 KERSEY RD
SILVER SPRING MD
20902-3054
US

V. Phone/Fax

Practice location:
  • Phone: 301-689-7500
  • Fax:
Mailing address:
  • Phone: 410-877-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NATHAN JAKOBOVITS
Title or Position: MANAGER
Credential:
Phone: 732-779-1030