Provider Demographics
NPI:1679574800
Name:NURSING HOME BOARD OF ALLEGANY COUNTY
Entity Type:Organization
Organization Name:NURSING HOME BOARD OF ALLEGANY COUNTY
Other - Org Name:LIONS CENTER FOR REHABILIATION AND EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAINES
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:301-722-6272
Mailing Address - Street 1:901 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1817
Mailing Address - Country:US
Mailing Address - Phone:301-722-6272
Mailing Address - Fax:301-722-0754
Practice Address - Street 1:901 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-722-6272
Practice Address - Fax:301-722-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD011767600Medicaid
MD215073Medicare ID - Type Unspecified