MEDICARE: SPRING MEADOWS ASSISTED LIVING

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	174400000X	Specialist	15AL0345	MD

General Provider Information

NPI Number	:	1578629358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING MEADOWS ASSISTED LIVING

Provider Business Mailing Address
First Line	:	3420 KILKENNY ST
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1737
Country	:	US
Telephone Number	:	301-572-7655
Fax Number	:	301-572-7655

Provider Business Practice Location Address
First Line	:	3420 KILKENNY ST
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-1737
Country	:	US
Telephone Number	:	301-572-7655
Fax Number	:	301-572-7655

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. MARY FLORA SUDAN
Credential	:	RN
Telephone Number	:	301-572-7655

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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Directions to “SPRING MEADOWS ASSISTED LIVING ” Practice Location

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