Healthcare Provider Details

I. General information

NPI: 1407839954
Provider Name (Legal Business Name): THE CHESTNUT PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W JOPPA RD
TOWSON MD
21204-3741
US

IV. Provider business mailing address

1055 W JOPPA RD
TOWSON MD
21204-3741
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-2900
  • Fax: 410-494-8236
Mailing address:
  • Phone: 410-296-2900
  • Fax: 410-494-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03-037
License Number StateMD

VII. Legacy identifiers

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

# 1
Identifier59016601
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST BLUECROSS BLUE

VIII. Authorized Official

Name: ALLISON D MERCURIS PENDROY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 515-875-4500