MEDICARE: ANNAPOLIS ASSISTED LIVING, 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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1881880326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNAPOLIS ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	800 BESTGATE RD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3016
Country	:	US
Telephone Number	:	410-266-1400
Fax Number	:	410-266-7560

Provider Business Practice Location Address
First Line	:	800 BESTGATE RD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3016
Country	:	US
Telephone Number	:	410-266-1400
Fax Number	:	410-266-7560

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	HONA MEYER
Credential	:
Telephone Number	:	410-266-1400

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/19/2007

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