=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861796765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAPSON SENIOR QUARTERS CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2011
-----------------------------------------------------
Last Update Date | 01/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 HEALTHWAY DR
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-546-9997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1110 HEALTHWAY DR
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21804-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-546-9997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL COUNSEL
-----------------------------------------------------
Name | BRYAN HUDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 502-779-7683
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------