Provider Demographics
NPI:1316210214
Name:PIKESVILLE ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:PIKESVILLE ASSISTED LIVING, LLC
Other - Org Name:SUNRISE OF PIKESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-602-0033
Mailing Address - Street 1:3800 OLD COURT RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3810
Mailing Address - Country:US
Mailing Address - Phone:410-602-0033
Mailing Address - Fax:410-602-0727
Practice Address - Street 1:3800 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3810
Practice Address - Country:US
Practice Address - Phone:410-602-0033
Practice Address - Fax:410-602-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03AL0670-F310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility