Healthcare Provider Details

I. General information

NPI: 1174558910
Provider Name (Legal Business Name): OAK CREST VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 WALTHER BLVD ATTN: HOME HEALTH ADMINISTRATOR
PARKVILLE MD
21234-9025
US

IV. Provider business mailing address

8820 WALTHER BLVD ATTN: EXECUTIVE DIRECTOR
PARKVILLE MD
21234-9025
US

V. Phone/Fax

Practice location:
  • Phone: 410-655-1000
  • Fax: 410-204-7237
Mailing address:
  • Phone: 410-655-1000
  • Fax: 410-204-7237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHH7155
License Number StateMD

VIII. Authorized Official

Name: JAMES K WALTER
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 410-402-2315