Healthcare Provider Details

I. General information

NPI: 1477888469
Provider Name (Legal Business Name): FAHRNEY-KEEDY MEMORIAL HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 PENNSYLVANIA AVE
HAGERSTOWN MD
21742-3108
US

IV. Provider business mailing address

1304 PENNSYLVANIA AVE
HAGERSTOWN MD
21742-3108
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-2914
  • Fax: 301-733-2078
Mailing address:
  • Phone: 301-733-2914
  • Fax: 301-733-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number21-004
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier417162400
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer

VIII. Authorized Official

Name: STEPHEN COETZEE
Title or Position: PRESIDENT/CEO
Credential: LNHA
Phone: 301-671-5017