Healthcare Provider Details

I. General information

NPI: 1013905579
Provider Name (Legal Business Name): THE VILLAGE AT ROCKVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 VEIRS DR
ROCKVILLE MD
20850-3462
US

IV. Provider business mailing address

9701 VEIRS DR
ROCKVILLE MD
20850-3414
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-9560
  • Fax: 301-424-9574
Mailing address:
  • Phone: 301-424-9560
  • Fax: 301-424-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15036
License Number StateMD

VIII. Authorized Official

Name: MICHAEL J. BRADY
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 301-424-9560