Provider Demographics
NPI:1851392278
Name:FALLSTON NURSING & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:FALLSTON NURSING & REHABILITATION CENTER INC
Other - Org Name:LORIEN RIVERSIDE NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-750-5700
Mailing Address - Street 1:1123 BELCAMP GARTH
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1452
Mailing Address - Country:US
Mailing Address - Phone:410-575-6400
Mailing Address - Fax:410-575-6450
Practice Address - Street 1:1123 BELCAMP GARTH
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1452
Practice Address - Country:US
Practice Address - Phone:410-575-6400
Practice Address - Fax:410-575-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD120007100Medicaid
MD120007100Medicaid