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General NPI Number Information
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NPI Number | 1316210214
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Entity Type | Organization
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Legal Business Name | PIKESVILLE ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 3800 OLD COURT RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-3810
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Country | US
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Telephone | 410-602-0033
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Fax | 410-602-0727
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Provider Business Mailing Address
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Address Line | 3800 OLD COURT RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-3810
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Country | US
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Telephone | 410-602-0033
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Fax | 410-602-0727
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LYNNETTE WALSCH
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Credential |
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Telephone | 410-602-0033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 03AL0670-F
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License Number State | MD
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