Provider Demographics
NPI:1265717011
Name:PRESBYTERIAN HOME OF MARYLAND, INC.
Entity type:Organization
Organization Name:PRESBYTERIAN HOME OF MARYLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-823-4622
Mailing Address - Street 1:400 GEORGIA CT
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4310
Mailing Address - Country:US
Mailing Address - Phone:410-823-4622
Mailing Address - Fax:410-823-0598
Practice Address - Street 1:400 GEORGIA CT
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4310
Practice Address - Country:US
Practice Address - Phone:410-823-4622
Practice Address - Fax:410-823-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility