MEDICARE: SANDTOWN WINCHESTER NURSING HOME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	30-094	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043214745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDTOWN WINCHESTER NURSING HOME, LLC

Provider Business Mailing Address
First Line	:	8028 RITCHIE HWY
Second Line	:	STE 210B
City	:	PASADENA
State	:	MD
Zip	:	21122-1059
Country	:	US
Telephone Number	:	410-766-1995
Fax Number	:	410-761-6095

Provider Business Practice Location Address
First Line	:	1000 N GILMOR ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-2207
Country	:	US
Telephone Number	:	410-669-2750
Fax Number	:	410-669-3875

Authorized Official
Title or Position	:	CFO/VP OF FINANCE
Name	:	BRIAN FINGLASS
Credential	:
Telephone Number	:	410-766-1995

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	09/17/2009

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