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NPI Code Detail

MEDICARE: CROFTON CONVALESCENT CENTER, INC.

MEDICARE: CROFTON CONVALESCENT CENTER, INC.
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
1314000000XSkilled Nursing Facility02-011MD

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 : 1093782468
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROFTON CONVALESCENT CENTER, INC.
Provider Business Mailing Address
First Line : 2131 DAVIDSONVILLE RD
Second Line :
City : CROFTON
State : MD
Zip : 21114-1632
Country : US
Telephone Number : 410-721-1000
Fax Number : 410-721-2749
Provider Business Practice Location Address
First Line : 2131 DAVIDSONVILLE RD
Second Line :
City : CROFTON
State : MD
Zip : 21114-1632
Country : US
Telephone Number : 410-721-1000
Fax Number : 410-721-2749
Authorized Official
Title or Position : NURSING HOME ADMINISTRATOR
Name : MR. PHILIP J GORDON
Credential :
Telephone Number : 410-721-1000
Provider Enumeration Date : 03/03/2006
Last Update Date : 08/14/2012

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Directions to “CROFTON CONVALESCENT CENTER, INC. ” Practice Location

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