Healthcare Provider Details

I. General information

NPI: 1366720088
Provider Name (Legal Business Name): AURORA SENIOR LIVING OF MANOKIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11974 EDGEHILL TERRACE RD
PRINCESS ANNE MD
21853-2105
US

IV. Provider business mailing address

11974 EDGEHILL TERRACE RD
PRINCESS ANNE MD
21853-2105
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-4697
  • Fax: 410-543-4471
Mailing address:
  • Phone: 410-543-4697
  • Fax: 410-543-4471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE OWENS
Title or Position: DIRECTOR, REIMBURSEMENT
Credential:
Phone: 410-729-8406