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NPI Code Detail

MEDICARE: MID-ATLANTIC OF FAIRFIELD, LLC

MEDICARE: MID-ATLANTIC OF FAIRFIELD, 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 Facility02-008MD

General Provider Information

NPI Number : 1285775627
Entity Type Code : Organization
Provider Name (Legal Business Name) : MID-ATLANTIC OF FAIRFIELD, LLC
Provider Business Mailing Address
First Line : 1454 FAIRFIELD LOOP RD
Second Line :
City : CROWNSVILLE
State : MD
Zip : 21032-2006
Country : US
Telephone Number : 410-923-6820
Fax Number : 410-987-9157
Provider Business Practice Location Address
First Line : 1454 FAIRFIELD LOOP RD
Second Line :
City : CROWNSVILLE
State : MD
Zip : 21032-2006
Country : US
Telephone Number : 410-923-6820
Fax Number : 410-987-9157
Authorized Official
Title or Position : CEO
Name : MR. SCOTT RIFKIN
Credential : M.D.
Telephone Number : 410-308-2300
Provider Enumeration Date : 02/09/2007
Last Update Date : 08/22/2020

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