Provider Demographics
NPI:1669460754
Name:LITTLE SISTERS OF THE POOR BALTIMORE INC
Entity Type:Organization
Organization Name:LITTLE SISTERS OF THE POOR BALTIMORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRENON
Authorized Official - Suffix:
Authorized Official - Credentials:RN 35726
Authorized Official - Phone:410-744-9367
Mailing Address - Street 1:601 MAIDEN CHOICE LN
Mailing Address - Street 2:ST MARTINS HOME
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3630
Mailing Address - Country:US
Mailing Address - Phone:410-744-9367
Mailing Address - Fax:410-744-6380
Practice Address - Street 1:601 MAIDEN CHOICE LN
Practice Address - Street 2:ST MARTINS HOME
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3630
Practice Address - Country:US
Practice Address - Phone:410-744-9367
Practice Address - Fax:410-744-6380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D0649848313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD032707700Medicaid
MD21D0649848OtherCLIA
MD215354OtherMEDICARE PTAN