Healthcare Provider Details

I. General information

NPI: 1720709157
Provider Name (Legal Business Name): LEXINGTON PARK MD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21412 GREAT MILLS RD
LEXINGTON PARK MD
20653-1203
US

IV. Provider business mailing address

21412 GREAT MILLS RD
LEXINGTON PARK MD
20653-1203
US

V. Phone/Fax

Practice location:
  • Phone: 301-863-7244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MOSHE MAYER
Title or Position: MANAGER
Credential:
Phone: 301-863-7244