MEDICARE: CAROLYN PEOPLES ASSISTED LIVING PROV

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	310400000X	Assisted Living Facility	30AL2883	MD

General Provider Information

NPI Number	:	1235251315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN PEOPLES ASSISTED LIVING PROV

Provider Business Mailing Address
First Line	:	4321 MARY RIDGE DR
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-4302
Country	:	US
Telephone Number	:	410-496-1550
Fax Number	:	410-521-3546

Provider Business Practice Location Address
First Line	:	2607 ELSINORE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-2126
Country	:	US
Telephone Number	:	410-578-0054
Fax Number	:	410-521-3546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/09/2007

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Directions to “ CAROLYN PEOPLES ASSISTED LIVING PROV” Practice Location

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