Healthcare Provider Details

I. General information

NPI: 1972016905
Provider Name (Legal Business Name): PRINCE GEORGES POST ACUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 BRIGHTSEAT ROAD
LANDOVER MD
20785
US

IV. Provider business mailing address

8028 RITCHIE HWY STE 210B
PASADENA MD
21122-1059
US

V. Phone/Fax

Practice location:
  • Phone: 410-766-1995
  • Fax:
Mailing address:
  • Phone: 410-766-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIAN FINGLASS
Title or Position: CFO
Credential:
Phone: 410-766-1995