Provider Demographics
NPI:1962453506
Name:JULIA MANOR LLC
Entity Type:Organization
Organization Name:JULIA MANOR LLC
Other - Org Name:JULIA MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-8700
Mailing Address - Street 1:333 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6473
Mailing Address - Country:US
Mailing Address - Phone:301-665-8700
Mailing Address - Fax:301-393-0804
Practice Address - Street 1:333 MILL ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6473
Practice Address - Country:US
Practice Address - Phone:301-665-8700
Practice Address - Fax:301-393-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-009314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD79OtherBLUE CROSS/BLUE SHIELD #
MD215321Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER