Provider Demographics
NPI:1235251315
Name:PEOPLES, CAROLYN (ASSISTED LIVING PROV)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:ASSISTED LIVING PROV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 MARY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4302
Mailing Address - Country:US
Mailing Address - Phone:410-496-1550
Mailing Address - Fax:410-521-3546
Practice Address - Street 1:2607 ELSINORE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2126
Practice Address - Country:US
Practice Address - Phone:410-578-0054
Practice Address - Fax:410-521-3546
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30AL2883310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility