Provider Demographics
NPI:1639186695
Name:FAHRNEY-KEEDY MEMORIAL HOME, INC
Entity Type:Organization
Organization Name:FAHRNEY-KEEDY MEMORIAL HOME, INC
Other - Org Name:COFFMAN NURSING HOME BY FAHRNEY-KEEDY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:COETZEE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:301-671-5017
Mailing Address - Street 1:8507 MAPLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOONSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21713-1818
Mailing Address - Country:US
Mailing Address - Phone:301-733-6284
Mailing Address - Fax:301-733-2733
Practice Address - Street 1:1304 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3108
Practice Address - Country:US
Practice Address - Phone:301-733-2914
Practice Address - Fax:301-733-2078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAHRNEY-KEEDY MEMORIAL HOME, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-02
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21004313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD235407100Medicaid
MD217247000Medicaid