Healthcare Provider Details

I. General information

NPI: 1467446914
Provider Name (Legal Business Name): ST. MARY'S NURSING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21585 PEABODY STREET
LEONARDTOWN MD
20650-2955
US

IV. Provider business mailing address

21585 PEABODY STREET
LEONARDTOWN MD
20650
US

V. Phone/Fax

Practice location:
  • Phone: 301-475-8000
  • Fax: 301-475-3085
Mailing address:
  • Phone: 301-475-8000
  • Fax: 301-475-3085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number18002
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LOIS ANNETTE HODGES
Title or Position: ADMINSTRATOR
Credential:
Phone: 301-475-8000