Provider Demographics
NPI:1386632800
Name:FUTURE CARE-CHARLES VILLAGE, LLC
Entity Type:Organization
Organization Name:FUTURE CARE-CHARLES VILLAGE, LLC
Other - Org Name:FUTURECARE CHARLES VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-766-1995
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-766-1995
Mailing Address - Fax:410-761-6095
Practice Address - Street 1:2327 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5128
Practice Address - Country:US
Practice Address - Phone:410-889-8500
Practice Address - Fax:410-889-7726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-106314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400813800OtherMEDICAID DME
MD400685200Medicaid
MD400813800OtherMEDICAID DME
215324Medicare Oscar/Certification