Provider Demographics
NPI:1417716218
Name:REHOBOTH GOD HAS MADE ROOM AL
Entity Type:Organization
Organization Name:REHOBOTH GOD HAS MADE ROOM AL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:443-845-3917
Mailing Address - Street 1:1031 HARTMONT RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1246
Mailing Address - Country:US
Mailing Address - Phone:443-845-3917
Mailing Address - Fax:
Practice Address - Street 1:125 NUNNERY LN
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2029
Practice Address - Country:US
Practice Address - Phone:443-845-3917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility