Healthcare Provider Details

I. General information

NPI: 1184716862
Provider Name (Legal Business Name): PICKERSGILL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 CHESTNUT AVE
TOWSON MD
21204-3742
US

IV. Provider business mailing address

615 CHESTNUT AVE
TOWSON MD
21204-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-6275
  • Fax:
Mailing address:
  • Phone: 410-825-7423
  • Fax: 410-821-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03-001
License Number StateMD

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. BRANT C HART
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-825-7423