Provider Demographics
NPI:1053069146
Name:PLATINUM NURSING AND ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:PLATINUM NURSING AND ASSISTED LIVING LLC
Other - Org Name:PLATINUM LIVING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-240-3695
Mailing Address - Street 1:6900 REAL PRINCESS LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4578
Mailing Address - Country:US
Mailing Address - Phone:410-240-3695
Mailing Address - Fax:
Practice Address - Street 1:6900 REAL PRINCESS LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4578
Practice Address - Country:US
Practice Address - Phone:410-240-3695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle