Provider Demographics
NPI:1922550839
Name:THE GALLION MANOR
Entity Type:Organization
Organization Name:THE GALLION MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:443-896-8135
Mailing Address - Street 1:3015 OAK GREEN CT
Mailing Address - Street 2:APT A
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3523
Mailing Address - Country:US
Mailing Address - Phone:443-896-8135
Mailing Address - Fax:
Practice Address - Street 1:3015 OAK GREEN CT
Practice Address - Street 2:APT A
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3523
Practice Address - Country:US
Practice Address - Phone:443-896-8135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility