Provider Demographics
NPI:1164574604
Name:HCR MANORCARE TOWSON
Entity Type:Organization
Organization Name:HCR MANORCARE TOWSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-828-9494
Mailing Address - Street 1:509 E JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5404
Mailing Address - Country:US
Mailing Address - Phone:410-828-9494
Mailing Address - Fax:410-828-9180
Practice Address - Street 1:509 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5404
Practice Address - Country:US
Practice Address - Phone:410-828-9494
Practice Address - Fax:410-828-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-022314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216648OtherKAISER PERMANENTE PROV#
MDPW4OtherBC FEDERAL PROVIDER #
MDC 215054OtherUNITED AMERICAN PROVIDER
MD=========OtherTAX IDENTIFICATION NUMBER
MDPW4OtherBC FEDERAL PROVIDER #