Provider Demographics
NPI:1134120439
Name:LORIEN NURSING & REHAB CTR INC.
Entity Type:Organization
Organization Name:LORIEN NURSING & REHAB CTR INC.
Other - Org Name:LORIEN NURSING AND REHABILITATION CENTER - COLUMBIA
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-750-7500
Mailing Address - Street 1:6334 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3818
Mailing Address - Country:US
Mailing Address - Phone:410-531-5300
Mailing Address - Fax:410-531-4861
Practice Address - Street 1:6334 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3818
Practice Address - Country:US
Practice Address - Phone:410-531-5300
Practice Address - Fax:410-531-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134996699Medicaid
MD215112Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER