Healthcare Provider Details

I. General information

NPI: 1306222963
Provider Name (Legal Business Name): 2015 EAST WEST HIGHWAY OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 E WEST HWY
SILVER SPRING MD
20910-2602
US

IV. Provider business mailing address

2015 E WEST HWY
SILVER SPRING MD
20910-2602
US

V. Phone/Fax

Practice location:
  • Phone: 301-587-2400
  • Fax: 301-587-2401
Mailing address:
  • Phone: 301-587-2400
  • Fax: 301-587-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00000
License Number StateMD

VIII. Authorized Official

Name: MICHAEL T BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4742