Provider Demographics
NPI:1184844326
Name:KESWICK MULTI-CARE CENTER INC
Entity Type:Organization
Organization Name:KESWICK MULTI-CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:410-662-4293
Mailing Address - Street 1:700 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2104
Mailing Address - Country:US
Mailing Address - Phone:410-235-8860
Mailing Address - Fax:410-235-7425
Practice Address - Street 1:700 W 40TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2104
Practice Address - Country:US
Practice Address - Phone:410-235-8860
Practice Address - Fax:410-235-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD32-039207RG0300X, 103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC30935OtherRAILROAD PROVIDER #
MDC30935OtherRAILROAD PROVIDER #
MDD76183Medicare UPIN
MDK791Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
MDC57615Medicare UPIN
MDD74791Medicare UPIN
MDH50685Medicare UPIN
MDD76788Medicare UPIN