Provider Demographics
NPI:1467575431
Name:PINKETT'S ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:PINKETT'S ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-336-5394
Mailing Address - Street 1:1701 LYDONLEA WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3101
Mailing Address - Country:US
Mailing Address - Phone:410-336-5394
Mailing Address - Fax:410-464-6051
Practice Address - Street 1:1701 LYDONLEA WAY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-3101
Practice Address - Country:US
Practice Address - Phone:410-336-5394
Practice Address - Fax:410-464-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30AL2945310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility