Provider Demographics
NPI:1083241210
Name:FAHRNEY-KEEDY MEMORIAL HOME, INC.
Entity Type:Organization
Organization Name:FAHRNEY-KEEDY MEMORIAL HOME, INC.
Other - Org Name:JONE L. BOWMAN ADULT MEDICAL DAY CENTER AT FAHMEY-KEEDY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COETZEE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:301-671-5017
Mailing Address - Street 1:8507 MAPLEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713
Mailing Address - Country:US
Mailing Address - Phone:301-733-6284
Mailing Address - Fax:301-733-2733
Practice Address - Street 1:8560 SYMPHONY DRIVE
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713
Practice Address - Country:US
Practice Address - Phone:301-671-5193
Practice Address - Fax:301-671-5239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAHRNEY-KEEDY MEMORIAL HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-26
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care