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General NPI Number Information
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NPI Number | 1487946828
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Entity Type | Organization
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Legal Business Name | SCOTLAND MANOR
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 2900 BOARMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-6610
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Country | US
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Telephone | 443-205-7422
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Fax | 410-366-2108
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Provider Business Mailing Address
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Address Line | 2900 BOARMAN AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-6610
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Country | US
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Telephone | 443-205-7422
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Fax | 410-366-2108
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | MS. LARAE RENETTE WILSON
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Credential |
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Telephone | 443-205-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 30AL2686-B
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License Number State | MD
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