Provider Demographics
NPI:1144217423
Name:FREDERICK COUNTY MARYLAND
Entity Type:Organization
Organization Name:FREDERICK COUNTY MARYLAND
Other - Org Name:CITIZENS CARE AND REHABILITATION CENTER AT FREDERICK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEPIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-600-1753
Mailing Address - Street 1:1900 ROSEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-8249
Mailing Address - Country:US
Mailing Address - Phone:240-772-9200
Mailing Address - Fax:240-608-6467
Practice Address - Street 1:1900 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8249
Practice Address - Country:US
Practice Address - Phone:240-772-9200
Practice Address - Fax:240-608-6467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10-008314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103957100Medicaid
MD21-5105Medicare ID - Type UnspecifiedPROVIDER#