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General NPI Number Information
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NPI Number | 1801190947
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Entity Type | Organization
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Legal Business Name | FENWICK LANDING, LLC
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 11665 DOOLITTLE DR
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City | WALDORF
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State | MD
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Zip | 20602-2898
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Country | US
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Telephone | 301-749-7611
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Fax | 301-970-2459
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Provider Business Mailing Address
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Address Line | 11665 DOOLITTLE DR
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City | WALDORF
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State | MD
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Zip | 20602-2898
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Country | US
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Telephone | 301-749-7611
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Fax | 301-970-2459
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. KARIN M LAKIN
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Credential |
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Telephone | 301-749-7611
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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 | 08AL064F
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License Number State | MD
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