Healthcare Provider Details

I. General information

NPI: 1811993116
Provider Name (Legal Business Name): HOMEWOOD LIVING WILLIAMSPORT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16505 VIRGINIA AVE
WILLIAMSPORT MD
21795-1321
US

IV. Provider business mailing address

16505 VIRGINIA AVE
WILLIAMSPORT MD
21795-1321
US

V. Phone/Fax

Practice location:
  • Phone: 301-582-1628
  • Fax: 301-582-1815
Mailing address:
  • Phone: 301-582-1628
  • Fax: 301-582-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number21008
License Number StateMD

VIII. Authorized Official

Name: MRS. MELISSA L. HADLEY
Title or Position: SITE DIRECTOR
Credential:
Phone: 301-582-1628