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General NPI Number Information
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NPI Number | 1053069146
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Entity Type | Organization
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Legal Business Name | PLATINUM NURSING AND ASSISTED LIVING LLC
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 6900 REAL PRINCESS LN
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City | BALTIMORE
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State | MD
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Zip | 21207-4578
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Country | US
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Telephone | 410-240-3695
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Fax |
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Provider Business Mailing Address
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Address Line | 6900 REAL PRINCESS LN
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City | BALTIMORE
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State | MD
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Zip | 21207-4578
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Country | US
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Telephone | 410-240-3695
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. DESHA RENEE JONES
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Credential |
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Telephone | 410-240-3695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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