Provider Demographics
NPI:1275390221
Name:PRIORITY ASSISTED LIVING MANOR LLC
Entity Type:Organization
Organization Name:PRIORITY ASSISTED LIVING MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM NERRY
Authorized Official - Middle Name:NKENYEH
Authorized Official - Last Name:NUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-602-0785
Mailing Address - Street 1:3904 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7420
Mailing Address - Country:US
Mailing Address - Phone:240-602-0785
Mailing Address - Fax:
Practice Address - Street 1:1104 POPLAR GROVE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4340
Practice Address - Country:US
Practice Address - Phone:240-602-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility