MEDICARE: 2015 EAST WEST HIGHWAY OPERATIONS 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
1	314000000X	Skilled Nursing Facility	00000	MD

General Provider Information

NPI Number	:	1306222963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2015 EAST WEST HIGHWAY OPERATIONS LLC

Provider Business Mailing Address
First Line	:	2015 E WEST HWY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2602
Country	:	US
Telephone Number	:	301-587-2400
Fax Number	:	301-587-2401

Provider Business Practice Location Address
First Line	:	2015 E WEST HWY
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2602
Country	:	US
Telephone Number	:	301-587-2400
Fax Number	:	301-587-2401

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MICHAEL T BERG
Credential	:
Telephone Number	:	505-468-4742

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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