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NPI Code Detail

MEDICARE: CROWNSVILLE HEALTH CARE LLC

MEDICARE: CROWNSVILLE HEALTH CARE 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 FacilityMD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649725797
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROWNSVILLE HEALTH CARE 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 : PRESIDENT
Name : CHARLES WOODBERRY
Credential :
Telephone Number : 410-923-6820
Provider Enumeration Date : 08/18/2016
Last Update Date : 02/10/2026

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