=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164708160
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUR BEST WAY HOME, ALF
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2011
-----------------------------------------------------
Last Update Date | 10/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3625 CEDAR DR
-----------------------------------------------------
City | GWYNN OAK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21207-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-821-9600
-----------------------------------------------------
Fax | 410-821-3790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3625 CEDAR DR
-----------------------------------------------------
City | GWYNN OAK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21207-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-821-9600
-----------------------------------------------------
Fax | 410-821-3790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CHRISTINE D. MATTIS-MYRIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-821-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 03AL1106-A
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------