Healthcare Provider Details

I. General information

NPI: 1376889121
Provider Name (Legal Business Name): LORIEN LIFE CENTER HARFORD II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BLENHEIM FARM LANE
HAVRE DE GRACE MD
21078
US

IV. Provider business mailing address

1501 BLENHEIM FARM LANE
HAVRE DE GRACE MD
21078
US

V. Phone/Fax

Practice location:
  • Phone: 410-750-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS G. GRIMMEL SR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 410-750-7500