Healthcare Provider Details

I. General information

NPI: 1609614007
Provider Name (Legal Business Name): VOANS SENIOR COMMUNITY CARE OF MARYLAND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 ANNAPOLIS RD
LANHAM MD
20706-1309
US

IV. Provider business mailing address

7485 OFFICE RIDGE CIR
EDEN PRAIRIE MN
55344-3690
US

V. Phone/Fax

Practice location:
  • Phone: 952-941-0305
  • Fax:
Mailing address:
  • Phone: 952-941-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: NANCY GAVIN
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 612-428-7840