Healthcare Provider Details

I. General information

NPI: 1437791977
Provider Name (Legal Business Name): ALCOVE MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2019
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax: 330-267-4250
Mailing address:
  • Phone: 330-536-3746
  • Fax: 330-267-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROCCO CONIGLIO
Title or Position: OWNER
Credential:
Phone: 330-969-9019