Provider Demographics
NPI:1588831580
Name:SANDRA'S NURSING SERVICES, LLC
Entity Type:Organization
Organization Name:SANDRA'S NURSING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH AND NURSING SERV
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:TREASE
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-212-7106
Mailing Address - Street 1:9724 CHERYL FOREST COURT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3171
Mailing Address - Country:US
Mailing Address - Phone:301-212-7106
Mailing Address - Fax:301-212-7108
Practice Address - Street 1:9724 CHERYL FOREST COURT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-3171
Practice Address - Country:US
Practice Address - Phone:301-212-7106
Practice Address - Fax:301-212-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR132785251J00000X
MD251J00000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5697804500Medicaid
MD56978053-00Medicaid
MD697805300Medicaid