Healthcare Provider Details

I. General information

NPI: 1811155369
Provider Name (Legal Business Name): CHARLES COUNTY NURSING AND REHAB CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 LAPIATA RD
LAPIATA MD
20646-3245
US

IV. Provider business mailing address

10200 LAPIATA RD
LAPIATA MD
20646-3245
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-1900
  • Fax: 301-934-8706
Mailing address:
  • Phone: 301-934-1900
  • Fax: 301-934-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MORRIS HOLMAN JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 301-934-1900