Provider Demographics
NPI:1801190947
Name:FENWICK LANDING, LLC
Entity Type:Organization
Organization Name:FENWICK LANDING, LLC
Other - Org Name:THE DUNROVEN AND THE DAGSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-749-7611
Mailing Address - Street 1:11665 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2898
Mailing Address - Country:US
Mailing Address - Phone:301-749-7611
Mailing Address - Fax:301-970-2459
Practice Address - Street 1:11665 DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2898
Practice Address - Country:US
Practice Address - Phone:301-749-7611
Practice Address - Fax:301-970-2459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08AL064F310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility