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NPI Code Detail

MEDICARE: WASHINGTON ROAD HEALTH CARE LLC

MEDICARE: WASHINGTON ROAD HEALTH CARE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1174078380
Entity Type Code : Organization
Provider Name (Legal Business Name) : WASHINGTON ROAD HEALTH CARE LLC
Provider Business Mailing Address
First Line : 920 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1234 WASHINGTON RD
Second Line :
City : WESTMINSTER
State : MD
Zip : 21157-5854
Country : US
Telephone Number : 410-773-1000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : KAM MCGAVOCK
Credential :
Telephone Number : 410-773-1000
Provider Enumeration Date : 08/17/2016
Last Update Date : 08/17/2016

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Directions to “WASHINGTON ROAD HEALTH CARE LLC ” Practice Location

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