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NPI Code Detail

MEDICARE: FCOC LLC

MEDICARE: FCOC 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
1261QP2000XPhysical Therapy Clinic/Center
2314000000XSkilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number : 1073960621
Entity Type Code : Organization
Provider Name (Legal Business Name) : FCOC LLC
Provider Business Mailing Address
First Line : 8028 RITCHIE HWY
Second Line : SUITE 210B
City : PASADENA
State : MD
Zip : 21122-1075
Country : US
Telephone Number : 410-766-1995
Fax Number : 410-761-6095
Provider Business Practice Location Address
First Line : 5412 OLD COURT RD
Second Line :
City : RANDALLSTOWN
State : MD
Zip : 21133-5104
Country : US
Telephone Number : 410-922-3200
Fax Number : 410-922-8521
Authorized Official
Title or Position : CFO
Name : MR. BRIAN FINGLASS
Credential : CPA
Telephone Number : 410-766-1995
Provider Enumeration Date : 05/24/2016
Last Update Date : 05/24/2016

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