Provider Demographics
NPI:1326047440
Name:CHESTER RIVER MANOR, INC
Entity Type:Organization
Organization Name:CHESTER RIVER MANOR, INC
Other - Org Name:UM- SHORE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-4550
Mailing Address - Street 1:200 MORGNEC ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1026
Mailing Address - Country:US
Mailing Address - Phone:410-778-4550
Mailing Address - Fax:410-778-9374
Practice Address - Street 1:200 MORGNEC ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1026
Practice Address - Country:US
Practice Address - Phone:410-778-4550
Practice Address - Fax:410-778-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14-003314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD144747500Medicaid
MD21-5262Medicare UPIN