Healthcare Provider Details

I. General information

NPI: 1629013925
Provider Name (Legal Business Name): WICOMICO NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BOOTH ST
SALISBURY MD
21801-3006
US

IV. Provider business mailing address

PO BOX 2378
SALISBURY MD
21802-2378
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-8896
  • Fax: 410-742-4987
Mailing address:
  • Phone: 410-742-8896
  • Fax: 410-742-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number22006
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number22006
License Number StateMD

VIII. Authorized Official

Name: MRS. MARY E SCHWARTZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-742-8896