NPI 1629302401

Mary T Maryland

Organisation Intellectual Disabilities Intermediate Care Facility Severna Park, MD

Practice location

Address: 820 Ritchie Hwy STE 100, Severna Park, MD 21146-4111
Phone: (410) 544-6813
Fax: (410) 544-6818
Mailing address: 1555 118th Ln NW, Coon Rapids, MN 55448-7579

Authorised official

Name: Connie Winbauer
Title: Controller
Phone: (763) 862-5436

Registered specialties (2)

Intellectual Disabilities Intermediate Care Facility Primary

Nursing & Custodial Care Facilities Taxonomy 315P00000X

Other Intermediate Care Facility, Intellectual Disabilities providers in Maryland →

Developmentally Disabled Services Day Training Agency

Agencies Taxonomy 251C00000X

Other Day Training, Developmentally Disabled Services providers in Maryland →

Registry record

NPI: 1629302401
Entity type: Organization
NPI issued: 25 Sep 2009
Record last updated: 25 Sep 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.