Provider Demographics
NPI:1578629358
Name:SPRING MEADOWS ASSISTED LIVING
Entity Type:Organization
Organization Name:SPRING MEADOWS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FLORA
Authorized Official - Last Name:SUDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-572-7655
Mailing Address - Street 1:3420 KILKENNY ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1737
Mailing Address - Country:US
Mailing Address - Phone:301-572-7655
Mailing Address - Fax:301-572-7655
Practice Address - Street 1:3420 KILKENNY ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1737
Practice Address - Country:US
Practice Address - Phone:301-572-7655
Practice Address - Fax:301-572-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL0345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty