Provider Demographics
NPI:1689097297
Name:TAYLOR FARM ASSISTED LIVING INC.
Entity Type:Organization
Organization Name:TAYLOR FARM ASSISTED LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, CDP, WCC
Authorized Official - Phone:301-769-3702
Mailing Address - Street 1:21730 OSCAR HAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:BUSHWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20618-2408
Mailing Address - Country:US
Mailing Address - Phone:301-769-3702
Mailing Address - Fax:301-769-3429
Practice Address - Street 1:21730 OSCAR HAYDEN RD
Practice Address - Street 2:
Practice Address - City:BUSHWOOD
Practice Address - State:MD
Practice Address - Zip Code:20618-2408
Practice Address - Country:US
Practice Address - Phone:301-769-3702
Practice Address - Fax:301-769-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18AL0016-C310400000X
MD18AL0012E310400000X
MD18AL0013-E310400000X
MD18AL0015D310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility