Provider Demographics
NPI:1336297431
Name:LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC
Entity Type:Organization
Organization Name:LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC
Other - Org Name:LEVINDALE PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-601-2246
Mailing Address - Street 1:2434 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5202
Mailing Address - Country:US
Mailing Address - Phone:410-547-8500
Mailing Address - Fax:
Practice Address - Street 1:2434 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5202
Practice Address - Country:US
Practice Address - Phone:410-547-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30088281P00000X
MD8204314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD900591900Medicaid
MDCE3212OtherR/R MEDICARE
MD900591900Medicaid
MDH330Medicare PIN