Healthcare Provider Details

I. General information

NPI: 1629572508
Provider Name (Legal Business Name): CHERRY LANE OPERATING GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 CHERRY LN
LAUREL MD
20708-1120
US

IV. Provider business mailing address

14C 53RD ST STE 220
BROOKLYN NY
11232-2644
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-8558
  • Fax: 301-317-1851
Mailing address:
  • Phone: 877-567-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SAM STERN
Title or Position: CFO
Credential:
Phone: 877-567-0402