Healthcare Provider Details

I. General information

NPI: 1831189042
Provider Name (Legal Business Name): CALVERT COUNTY NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HOSPITAL ROAD
PRINCE FREDERICK MD
20678-4018
US

IV. Provider business mailing address

85 HOSPITAL ROAD
PRINCE FREDERICK MD
20678-4018
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2300
  • Fax: 410-535-1505
Mailing address:
  • Phone: 410-535-2300
  • Fax: 410-535-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000X
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number04-002
License Number StateMD

VIII. Authorized Official

Name: MR. LARRY LEROY YOUNGER
Title or Position: ADMINISTRATOR
Credential: R1595 NURSING HOME A
Phone: 410-535-2300