Provider Demographics
NPI:1962484857
Name:CLOSUP I, INC.
Entity type:Organization
Organization Name:CLOSUP I, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAEANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-694-3100
Mailing Address - Street 1:5800 GENESIS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5116
Mailing Address - Country:US
Mailing Address - Phone:301-694-3100
Mailing Address - Fax:301-694-0745
Practice Address - Street 1:5800 GENESIS LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-5116
Practice Address - Country:US
Practice Address - Phone:301-694-3100
Practice Address - Fax:301-694-0745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10AL021310400000X
MD10AL011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility