Healthcare Provider Details

I. General information

NPI: 1316945181
Provider Name (Legal Business Name): 19301 WATKINS MILL ROAD OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19301 WATKINS MILL RD.
MONTGOMERY VILLAGE MD
20886
US

IV. Provider business mailing address

19301 WATKINS MILL RD.
MONTGOMERY VILLAGE MD
20886
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-2500
  • Fax: 301-527-2525
Mailing address:
  • Phone: 301-527-2500
  • Fax: 301-527-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. A. ALBERTO LUGO
Title or Position: EXECUTIVE VP & GENERAL COUNSEL
Credential:
Phone: 201-242-4000