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NPI Code Detail

MEDICARE: THI OF MARYLAND AT SOUTH RIVER LLC

MEDICARE: THI OF MARYLAND AT SOUTH RIVER 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 Facility02-013MD

General Provider Information

NPI Number : 1467490003
Entity Type Code : Organization
Provider Name (Legal Business Name) : THI OF MARYLAND AT SOUTH RIVER LLC
Provider Business Mailing Address
First Line : 930 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number : 410-773-1000
Fax Number :
Provider Business Practice Location Address
First Line : 144 WASHINGTON RD
Second Line :
City : EDGEWATER
State : MD
Zip : 21037-1412
Country : US
Telephone Number : 410-956-5000
Fax Number :
Authorized Official
Title or Position : EVP
Name : MATTHEW BOX
Credential :
Telephone Number : 410-773-1000
Provider Enumeration Date : 06/04/2006
Last Update Date : 09/21/2007

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Directions to “THI OF MARYLAND AT SOUTH RIVER LLC ” Practice Location

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