MEDICARE: BAY MANOR NURSING HOME, INC.

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	02-004	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1982068847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY MANOR NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	8028 RITCHIE HWY
Second Line	:	SUITE 210B
City	:	PASADENA
State	:	MD
Zip	:	21122-1075
Country	:	US
Telephone Number	:	410-766-1995
Fax Number	:	410-761-6095

Provider Business Practice Location Address
First Line	:	305 COLLEGE PKWY
Second Line	:
City	:	ARNOLD
State	:	MD
Zip	:	21012-2912
Country	:	US
Telephone Number	:	410-647-0015
Fax Number	:	410-647-0019

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MR. BRIAN FINGALSS
Credential	:	CFO
Telephone Number	:	410-766-1995

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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