Healthcare Provider Details

I. General information

NPI: 1932629607
Provider Name (Legal Business Name): LP LEXINGTON PARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21412 GREAT MILLS RD
LEXINGTON PARK MD
20653-1203
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 301-863-7244
  • Fax:
Mailing address:
  • Phone: 508-568-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800