Provider Demographics
NPI:1578566899
Name:CITIZENS NURSING HOME BOARD OF HARFORD COUNTY
Entity Type:Organization
Organization Name:CITIZENS NURSING HOME BOARD OF HARFORD COUNTY
Other - Org Name:CITIZENS CARE & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:410-939-5500
Mailing Address - Street 1:415 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3301
Mailing Address - Country:US
Mailing Address - Phone:410-939-5500
Mailing Address - Fax:410-939-3471
Practice Address - Street 1:415 MARKET ST
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3301
Practice Address - Country:US
Practice Address - Phone:410-939-5500
Practice Address - Fax:410-939-3471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
0420390001OtherNSC
0420390001OtherNSC