=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558531913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKVILLE NURSING AND REHABILITATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2008
-----------------------------------------------------
Last Update Date | 03/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8503 HARFORD RD SUITE F
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-661-1582
-----------------------------------------------------
Fax | 410-661-1583
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8503 HARFORD RD SUITE F
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-661-1582
-----------------------------------------------------
Fax | 410-661-1583
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. LINNETTE MILES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-661-1582
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R2583
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------