Provider Demographics
NPI:1093465577
Name:HOLBROCK ESTATES AT THE MARTIN DE PORRES CENTER LLC
Entity Type:Organization
Organization Name:HOLBROCK ESTATES AT THE MARTIN DE PORRES CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:437-085-0564
Mailing Address - Street 1:3310 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4108
Mailing Address - Country:US
Mailing Address - Phone:443-708-5056
Mailing Address - Fax:
Practice Address - Street 1:908 VALLEY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5460
Practice Address - Country:US
Practice Address - Phone:443-708-5056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness