MEDICARE: A PLACE JUST FOR ME

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	04A1.0060-A	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04A1.0060-A	OTHER	MD	STATE OF MARYLAND DEPART OF HEALTH OFFICE OF HEALTH CARE QUALITY

General Provider Information

NPI Number	:	1568944858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A PLACE JUST FOR ME

Provider Business Mailing Address
First Line	:	4670 WILLIAMS WHARF RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-3044
Country	:	US
Telephone Number	:	443-684-2214
Fax Number	:	443-951-9005

Provider Business Practice Location Address
First Line	:	4670 WILLIAMS WHARF RD
Second Line	:
City	:	SAINT LEONARD
State	:	MD
Zip	:	20685-3044
Country	:	US
Telephone Number	:	443-684-2214
Fax Number	:	443-951-9005

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. ROBERT TERRY GRAHAM
Credential	:	NDP
Telephone Number	:	443-684-2214

Provider Enumeration Date	:	09/03/2018
Last Update Date	:	09/03/2018

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Directions to “A PLACE JUST FOR ME ” Practice Location

Language	Start Address	Practice Location

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