Provider Demographics
NPI:1770038838
Name:WESTERNPORT HEALTH CARE LLC
Entity Type:Organization
Organization Name:WESTERNPORT HEALTH CARE LLC
Other - Org Name:MORAN NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-359-3000
Mailing Address - Street 1:25701 SHADY LN SW
Mailing Address - Street 2:
Mailing Address - City:WESTERNPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21562-2017
Mailing Address - Country:US
Mailing Address - Phone:301-359-3000
Mailing Address - Fax:301-359-0121
Practice Address - Street 1:25701 SHADY LN SW
Practice Address - Street 2:
Practice Address - City:WESTERNPORT
Practice Address - State:MD
Practice Address - Zip Code:21562-2017
Practice Address - Country:US
Practice Address - Phone:301-359-3000
Practice Address - Fax:301-359-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD500178100Medicaid
215240Medicare Oscar/Certification