Provider Demographics
NPI:1609072735
Name:MARLEA MANOR ASSISTED LIVING
Entity Type:Organization
Organization Name:MARLEA MANOR ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-592-8418
Mailing Address - Street 1:11106 TOWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1738
Mailing Address - Country:US
Mailing Address - Phone:410-592-8418
Mailing Address - Fax:410-592-3233
Practice Address - Street 1:4405 RASPE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1926
Practice Address - Country:US
Practice Address - Phone:410-488-3135
Practice Address - Fax:410-488-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30AL1440310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility