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General NPI Number Information
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NPI Number | 1578629358
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Entity Type | Organization
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Legal Business Name | SPRING MEADOWS ASSISTED LIVING
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3420 KILKENNY ST
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City | SILVER SPRING
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State | MD
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Zip | 20904-1737
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Country | US
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Telephone | 301-572-7655
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Fax | 301-572-7655
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Provider Business Mailing Address
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Address Line | 3420 KILKENNY ST
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City | SILVER SPRING
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State | MD
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Zip | 20904-1737
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Country | US
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Telephone | 301-572-7655
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Fax | 301-572-7655
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. MARY FLORA SUDAN
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Credential | RN
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Telephone | 301-572-7655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 15AL0345
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License Number State | MD
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