Provider Demographics
NPI:1649443904
Name:MASSERIA LLC
Entity type:Organization
Organization Name:MASSERIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHACKELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-821-0020
Mailing Address - Street 1:8501 LASALLE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5914
Mailing Address - Country:US
Mailing Address - Phone:410-821-0020
Mailing Address - Fax:410-821-0020
Practice Address - Street 1:8501 LASALLE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5914
Practice Address - Country:US
Practice Address - Phone:410-821-0020
Practice Address - Fax:410-821-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2555251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health