Healthcare Provider Details

I. General information

NPI: 1427002559
Provider Name (Legal Business Name): PLEASANT VIEW NURSING HOME OF MT. AIRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 OLD NATIONAL PIKE
MOUNT AIRY MD
21771-4115
US

IV. Provider business mailing address

4101 OLD NATIONAL PIKE
MOUNT AIRY MD
21771-4115
US

V. Phone/Fax

Practice location:
  • Phone: 301-829-0800
  • Fax: 410-442-4697
Mailing address:
  • Phone: 301-829-0800
  • Fax: 410-442-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13052
License Number StateMD

VIII. Authorized Official

Name: MS. SANDRA N. AYERS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 301-829-0800