Provider Demographics
NPI:1467150037
Name:ACADEMY MD OPCO
Entity Type:Organization
Organization Name:ACADEMY MD OPCO
Other - Org Name:FREDERICK VILLA HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-788-3300
Mailing Address - Street 1:711 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1802
Mailing Address - Country:US
Mailing Address - Phone:410-655-7373
Mailing Address - Fax:
Practice Address - Street 1:711 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1802
Practice Address - Country:US
Practice Address - Phone:410-788-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility