Provider Demographics
NPI:1376540856
Name:TOWSON REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:TOWSON REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FIORINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-296-8888
Mailing Address - Street 1:7401 OSLER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7673
Mailing Address - Country:US
Mailing Address - Phone:410-296-8888
Mailing Address - Fax:410-296-6745
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-296-8888
Practice Address - Fax:410-296-6745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA319813OtherBC/BS OF PENNSYLVANIA
PA1373021OtherHIMARK BC/BS OF PA
VA435557OtherANTHEM TRIGON
MD137008100Medicaid
MDLN91OtherBC/BS OF MARYLAND
TN4040326OtherBC/BS OF TENNESSEE
MDW226OtherFEDERAL BC/BS
MD137008100Medicaid
WI=========-012OtherBC/BS OF WISCONSIN