Healthcare Provider Details

I. General information

NPI: 1588651996
Provider Name (Legal Business Name): DENNETT ROAD MANOR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MARY DR
OAKLAND MD
21550-1428
US

IV. Provider business mailing address

1113 MARY DR
OAKLAND MD
21550-1428
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-8700
  • Fax: 301-334-8347
Mailing address:
  • Phone: 301-334-8700
  • Fax: 301-334-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11004
License Number StateMD

VIII. Authorized Official

Name: MR. LARRY L HOLLER
Title or Position: VICE PRESIDENT CFO
Credential:
Phone: 301-334-2111