Provider Demographics
NPI:1568826477
Name:CANTON HARBOR HEALTHCARE CENTER, INC
Entity Type:Organization
Organization Name:CANTON HARBOR HEALTHCARE CENTER, INC
Other - Org Name:FUTURECARE CANTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:410-766-1995
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-766-1995
Mailing Address - Fax:410-761-6095
Practice Address - Street 1:1300 S ELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4900
Practice Address - Country:US
Practice Address - Phone:410-342-6644
Practice Address - Fax:410-327-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3005038 00Medicaid
215176Medicare Oscar/Certification