Provider Demographics
NPI:1275537995
Name:CHARLES STREET HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CHARLES STREET HEALTHCARE, LLC
Other - Org Name:FUTURECARE NORTH CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-766-1995
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:STE 210B
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1059
Mailing Address - Country:US
Mailing Address - Phone:410-766-1995
Mailing Address - Fax:410-761-6095
Practice Address - Street 1:2700 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4300
Practice Address - Country:US
Practice Address - Phone:410-554-6300
Practice Address - Fax:410-554-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-018314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD790400200OtherMEDICAID DME
MD842825500Medicaid
MD790400200OtherMEDICAID DME
215249Medicare Oscar/Certification