Provider Demographics
NPI:1376081729
Name:CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:CHARLES COUNTY NURSING AND REHABILITATION CENTER, INC.
Other - Org Name:SAGEPOINT HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:301-753-3297
Mailing Address - Street 1:10200 LAPLATA RD
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3245
Mailing Address - Country:US
Mailing Address - Phone:301-753-3297
Mailing Address - Fax:
Practice Address - Street 1:10200 LAPLATA RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3245
Practice Address - Country:US
Practice Address - Phone:301-753-3297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY OF CARE ALLIANCE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3852253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care