Provider Demographics
NPI:1922087451
Name:RANDOLPH HILLS NURSING CARE, INC.
Entity Type:Organization
Organization Name:RANDOLPH HILLS NURSING CARE, INC.
Other - Org Name:RANDOLPH HILLS NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNG HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:301-933-2500
Mailing Address - Street 1:4011 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1000
Mailing Address - Country:US
Mailing Address - Phone:301-933-2500
Mailing Address - Fax:301-942-6992
Practice Address - Street 1:4011 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1000
Practice Address - Country:US
Practice Address - Phone:301-933-2500
Practice Address - Fax:301-942-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15025314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD065422100Medicaid
MD065422100Medicaid