Provider Demographics
NPI:1114118494
Name:LP CAMBRIDGE LLC
Entity Type:Organization
Organization Name:LP CAMBRIDGE LLC
Other - Org Name:SIGNATURE HEALTHCARE AT MALLARD BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-627-0664
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7800
Mailing Address - Fax:
Practice Address - Street 1:520 GLENBURN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1415
Practice Address - Country:US
Practice Address - Phone:410-228-9191
Practice Address - Fax:410-228-8350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP CS HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09-006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215191Medicare Oscar/Certification
6289520001Medicare NSC
6093650001Medicare NSC