Provider Demographics
NPI:1225008873
Name:COURTLAND GARDENS NURSING AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:COURTLAND GARDENS NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:JEWISH CONVALESCENT AND NURSING HOME INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSIT DIRECTOR PATIENT ACCOUNTS
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-2935
Mailing Address - Street 1:7920 SCOTTS LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2629
Mailing Address - Country:US
Mailing Address - Phone:410-601-2935
Mailing Address - Fax:410-601-2925
Practice Address - Street 1:7920 SCOTTS LEVEL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-2629
Practice Address - Country:US
Practice Address - Phone:410-521-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03055314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02VJOtherMD BLUE CROSS PROVIDER
MD032677100Medicaid
MDHW7OtherFEDERAL BLUE CROSS PROVID
MDHW7OtherFEDERAL BLUE CROSS PROVID
MDH330Medicare PIN