Healthcare Provider Details

I. General information

NPI: 1861499030
Provider Name (Legal Business Name): GLADE VALLEY NURSING & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 W FREDERICK ST
WALKERSVILLE MD
21793-8254
US

IV. Provider business mailing address

56 W FREDERICK ST
WALKERSVILLE MD
21793-8254
US

V. Phone/Fax

Practice location:
  • Phone: 301-898-4304
  • Fax: 301-898-4343
Mailing address:
  • Phone: 301-898-4304
  • Fax: 301-898-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICHARD A MARIZAN
Title or Position: DIRECTOR, CENTRAL BUSINESS OFFICE
Credential:
Phone: 301-315-3272