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General NPI Number Information
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NPI Number | 1861638470
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Entity Type | Organization
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Legal Business Name | FB PEYTON ROCK OF AGING,LLC
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 1421 CLARKVIEW RD SUITE 100B
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City | BALTIMORE
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State | MD
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Zip | 21209-2133
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Country | US
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Telephone | 410-583-1944
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Fax | 410-583-1966
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Provider Business Mailing Address
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Address Line | 1421 CLARKVIEW RD SUITE 100B
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City | BALTIMORE
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State | MD
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Zip | 21209-2133
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Country | US
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Telephone | 410-583-1944
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Fax | 410-583-1966
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | FBRADLEY PEYTON
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Credential | J.D., M.DIV.
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Telephone | 410-583-1944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 081001
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0810001
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License Number State | MD
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