Provider Demographics
NPI:1265219968
Name:GREAT HEARTS ASSISTED LIVING
Entity type:Organization
Organization Name:GREAT HEARTS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DELEGATING NURSE
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:ADGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-615-3377
Mailing Address - Street 1:1105 N STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2647
Mailing Address - Country:US
Mailing Address - Phone:202-615-3377
Mailing Address - Fax:
Practice Address - Street 1:1105 N STOCKTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2647
Practice Address - Country:US
Practice Address - Phone:202-615-3377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility