Healthcare Provider Details

I. General information

NPI: 1871424879
Provider Name (Legal Business Name): ALLSWELL ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 CRAWFORD DR
GLEN BURNIE MD
21061-4128
US

IV. Provider business mailing address

1125 CRAWFORD DR
GLEN BURNIE MD
21061-4128
US

V. Phone/Fax

Practice location:
  • Phone: 646-623-1247
  • Fax:
Mailing address:
  • Phone: 646-623-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PANKAJ KUMAR SHRIVASTAVA
Title or Position: ASSISTED LIVING MANAGER
Credential: PHARMACIST
Phone: 646-623-1247