Provider Demographics
NPI:1679928931
Name:MY SISTER'S PLACE, LLC
Entity Type:Organization
Organization Name:MY SISTER'S PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:TREASE
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-516-7404
Mailing Address - Street 1:21106 TALL CEDAR WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6051
Mailing Address - Country:US
Mailing Address - Phone:301-515-7404
Mailing Address - Fax:301-576-5448
Practice Address - Street 1:21106 TALL CEDAR WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6051
Practice Address - Country:US
Practice Address - Phone:301-515-7404
Practice Address - Fax:301-576-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-24
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15AL0519-A310400000X
MD15ALO519-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility