Provider Demographics
NPI:1457307563
Name:PERINI SERVICES DEVLIN MANOR LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:PERINI SERVICES DEVLIN MANOR LIMITED PARTNERSHIP
Other - Org Name:DEVLIN MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-8700
Mailing Address - Street 1:1710 UNDERPASS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6924
Mailing Address - Country:US
Mailing Address - Phone:301-745-8700
Mailing Address - Fax:301-790-3094
Practice Address - Street 1:10301 CHRISTIE RD NE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-8326
Practice Address - Country:US
Practice Address - Phone:301-724-1400
Practice Address - Fax:301-724-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01-015314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
02FWOtherCAREFIRST - PROV/INQ#
278464OtherAMERIGROUP
6179747OtherCIGNA-MID-ATLANTIC
5179670OtherAETNA-HMO
RT1OtherCAREFIRST-BLUECHOICE
2133398OtherUNITED - MAMSI
=========OtherMARYLAND PHYSICIAN CARE
=========OtherCAREFIRST - TIN
=========OtherJOHNS HOPKINS
02FWOtherCAREFIRST - PROV/INQ#
5179670OtherAETNA-HMO
=========OtherINFORMED
RT1OtherCAREFIRST-BLUECHOICE