MEDICARE: SOUTHEAST NURSING & REHABILITATION CENTER

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	30089	MD

General Provider Information

NPI Number	:	1740281005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST NURSING & REHABILITATION CENTER

Provider Business Mailing Address
First Line	:	5009 FRANKFORD AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-5353
Country	:	US
Telephone Number	:	410-325-4000
Fax Number	:	410-325-1348

Provider Business Practice Location Address
First Line	:	5009 FRANKFORD AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21206-5353
Country	:	US
Telephone Number	:	410-325-4000
Fax Number	:	410-325-1348

Authorized Official
Title or Position	:	CEO
Name	:	MR. LOUIS G GRIMMEL
Credential	:
Telephone Number	:	410-750-7500

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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