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NPI Code Detail

MEDICARE: ELLICOTT CITY NURSING AND REHAB CENTER LLC

MEDICARE: ELLICOTT CITY NURSING AND REHAB CENTER 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 Facility

General Provider Information

NPI Number : 1891652525
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLICOTT CITY NURSING AND REHAB CENTER LLC
Provider Business Mailing Address
First Line : 3000 N RIDGE RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-3311
Country : US
Telephone Number : 410-461-7577
Fax Number :
Provider Business Practice Location Address
First Line : 3000 N RIDGE RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-3311
Country : US
Telephone Number : 410-461-7577
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : JACK SHELBY
Credential :
Telephone Number : 917-414-2140
Provider Enumeration Date : 01/06/2026
Last Update Date : 01/06/2026

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Directions to “ELLICOTT CITY NURSING AND REHAB CENTER LLC ” Practice Location

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