Provider Demographics
NPI:1508023771
Name:CARAWAY MANOR ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:CARAWAY MANOR ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATTAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:410-392-0502
Mailing Address - Street 1:2375 OLD FIELD POINT RD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6713
Mailing Address - Country:US
Mailing Address - Phone:410-392-0502
Mailing Address - Fax:410-392-8092
Practice Address - Street 1:2375 OLD FIELD POINT RD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6713
Practice Address - Country:US
Practice Address - Phone:410-392-0502
Practice Address - Fax:410-392-8092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07AL026310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD242302200Medicaid
MD9456007-01Medicaid