Provider Demographics
NPI:1295011302
Name:SEVERNA PARK CENTER
Entity Type:Organization
Organization Name:SEVERNA PARK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHR
Authorized Official - Phone:610-925-4148
Mailing Address - Street 1:8671 SCORTON HARBOUR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6513
Mailing Address - Country:US
Mailing Address - Phone:410-360-2719
Mailing Address - Fax:
Practice Address - Street 1:8671 SCORTON HARBOUR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6513
Practice Address - Country:US
Practice Address - Phone:410-360-2719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA01790314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
245037OtherNBCOT
MDA01790OtherCOTA/L