Healthcare Provider Details

I. General information

NPI: 1144175894
Provider Name (Legal Business Name): PA TERRAPIN HEALTHARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9109 LIBERTY RD
RANDALLSTOWN MD
21133-3521
US

IV. Provider business mailing address

9109 LIBERTY RD
RANDALLSTOWN MD
21133-3521
US

V. Phone/Fax

Practice location:
  • Phone: 410-655-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LYNETTE KERR
Title or Position: SENIOR REGULATORY PARALEGAL
Credential:
Phone: 714-732-9380