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NPI Code Detail

MEDICARE: 2501 MUSGROVE ROAD OPCO LLC

MEDICARE: 2501 MUSGROVE ROAD OPCO 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
1313M00000XNursing Facility/Intermediate Care Facility
2385H00000XRespite Care
3314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1922708726
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2501 MUSGROVE ROAD OPCO LLC
Provider Business Mailing Address
First Line : 14C 53RD ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11232-2644
Country : US
Telephone Number : 877-567-0402
Fax Number :
Provider Business Practice Location Address
First Line : 2501 MUSGROVE RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-7128
Country : US
Telephone Number : 301-890-5552
Fax Number :
Authorized Official
Title or Position : CFO
Name : SAM STERN
Credential :
Telephone Number : 877-567-0402
Provider Enumeration Date : 03/09/2023
Last Update Date : 03/09/2023

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Directions to “2501 MUSGROVE ROAD OPCO LLC ” Practice Location

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