Provider Demographics
NPI:1295214393
Name:LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC
Entity Type:Organization
Organization Name:LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC
Other - Org Name:LIFEBRIDGE HEALTH ADULT DAY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSIT DIRECTOR PFS
Authorized Official - Prefix:
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:TIMONIUM BUSINESS PARK
Mailing Address - Street 2:1946 GREENSPRING DRIVE, SUITE R
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4152
Mailing Address - Country:US
Mailing Address - Phone:410-601-2935
Mailing Address - Fax:410-601-2925
Practice Address - Street 1:LIFEBRIDGE HEALTH ADULT DAY SERVICES
Practice Address - Street 2:5400 OLD COURT ROAD
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133
Practice Address - Country:US
Practice Address - Phone:410-601-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEVINDALE ADULT DAY CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-09
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD780093200Medicaid
MD272753600Medicaid
MD333894100Medicaid