Provider Demographics
NPI:1942241815
Name:NORTHAMPTON MANOR, INC.
Entity Type:Organization
Organization Name:NORTHAMPTON MANOR, INC.
Other - Org Name:NORTHAMPTON MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-8700
Mailing Address - Street 1:1710 UNDERPASS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6924
Mailing Address - Country:US
Mailing Address - Phone:301-745-8700
Mailing Address - Fax:301-790-3094
Practice Address - Street 1:200 E 16TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4400
Practice Address - Country:US
Practice Address - Phone:301-662-8700
Practice Address - Fax:301-662-4045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10-010314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10007900Medicaid
5179670OtherAETNA-NONHMO
02JTOtherCAREFIRST - PROV INQ #
2133399OtherUNITED - MAMSI
281224OtherAMERIGROUP
RU4OtherCAREFIRST - IND/PPO
RU4OtherCAREFIRST - BLUECHOICE
3970027OtherAETNA-HMO
MD10007900Medicaid
3970027OtherAETNA-HMO
02JTOtherCAREFIRST - PROV\INQ #
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