Healthcare Provider Details

I. General information

NPI: 1083831135
Provider Name (Legal Business Name): MT. EPHRAIM NONPROFIT COMM DEVEL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 LARGO RD GILMORE ADULT CARE CENTER
UPPER MARLBORO MD
20774-2122
US

IV. Provider business mailing address

608 LARGO RD GILMORE ADULT CARE CENTER
UPPER MARLBORO MD
20774-2122
US

V. Phone/Fax

Practice location:
  • Phone: 301-808-9808
  • Fax:
Mailing address:
  • Phone: 301-808-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number14024
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NURIA ALVAREZ
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 301-808-9808