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General NPI Number Information
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NPI Number | 1982641809
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Entity Type | Organization
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Legal Business Name | THI OF MARYLAND AT LIBERTY HEIGHTS LLC
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 09/21/2007
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Provider Practice Location Address
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Address Line | 4017 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21207-7545
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Country | US
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Telephone | 410-542-5306
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Fax |
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Provider Business Mailing Address
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Address Line | 930 RIDGEBROOK RD
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City | SPARKS
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State | MD
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Zip | 21152-9390
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Country | US
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Telephone | 410-773-1000
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Fax |
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Authorized Official
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Title or Position | EVP
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Name | MATTHEW BOX
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Credential |
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Telephone | 410-773-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 30-022
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License Number State | MD
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