Healthcare Provider Details

I. General information

NPI: 1164574604
Provider Name (Legal Business Name): HCR MANORCARE TOWSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 E JOPPA RD
TOWSON MD
21286-5404
US

IV. Provider business mailing address

509 E JOPPA RD
TOWSON MD
21286-5404
US

V. Phone/Fax

Practice location:
  • Phone: 410-828-9494
  • Fax: 410-828-9180
Mailing address:
  • Phone: 410-828-9494
  • Fax: 410-828-9180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03-022
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier216648
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerKAISER PERMANENTE PROV#
# 2
IdentifierPW4
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerBC FEDERAL PROVIDER #
# 3
IdentifierC 215054
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerUNITED AMERICAN PROVIDER

VIII. Authorized Official

Name: MR. DEAN A SMITH
Title or Position: NURSING HOME ADMINISTRATOR
Credential:
Phone: 410-828-9494