Provider Demographics
NPI:1588855860
Name:LP LEXINGTON PARK LLC
Entity Type:Organization
Organization Name:LP LEXINGTON PARK LLC
Other - Org Name:CHESAPEAKE SHORES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:21412 GREAT MILLS RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1203
Mailing Address - Country:US
Mailing Address - Phone:301-863-7244
Mailing Address - Fax:301-863-8550
Practice Address - Street 1:21412 GREAT MILLS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PK
Practice Address - State:MD
Practice Address - Zip Code:20653-1203
Practice Address - Country:US
Practice Address - Phone:301-863-7244
Practice Address - Fax:301-863-8550
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP CS HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18-003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215142Medicare Oscar/Certification