Provider Demographics
NPI:1083989180
Name:MORNINGSIDE HOUSE OF LAUREL,LLC
Entity Type:Organization
Organization Name:MORNINGSIDE HOUSE OF LAUREL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-669-1804
Mailing Address - Street 1:7700 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3603
Mailing Address - Country:US
Mailing Address - Phone:301-725-2220
Mailing Address - Fax:301-725-2443
Practice Address - Street 1:7700 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3603
Practice Address - Country:US
Practice Address - Phone:301-725-2220
Practice Address - Fax:301-725-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL0370F310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility