Provider Demographics
NPI:1114924115
Name:LONG VIEW NURSING HOME, INC.
Entity Type:Organization
Organization Name:LONG VIEW NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-239-7139
Mailing Address - Street 1:3332 MAIN ST
Mailing Address - Street 2:POB 390
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-0390
Mailing Address - Country:US
Mailing Address - Phone:410-239-7139
Mailing Address - Fax:410-239-6460
Practice Address - Street 1:3332 MAIN ST
Practice Address - Street 2:POB 390
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-0390
Practice Address - Country:US
Practice Address - Phone:410-239-7139
Practice Address - Fax:410-239-6460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06-006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD59016801OtherBC/BS
MD0412600001Medicare NSC
MD59016801OtherBC/BS