Provider Demographics
NPI:1811932742
Name:RANDALLSTOWN CENTER, LLC
Entity type:Organization
Organization Name:RANDALLSTOWN CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DROPESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4231
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:9109 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3521
Practice Address - Country:US
Practice Address - Phone:410-655-7373
Practice Address - Fax:410-644-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-031314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
340549OtherUNITED - MAMSI
71-00181OtherUNITED - EVERCARE
RY4OtherCAREFIRST - IND/PPO
1077856OtherAETNA-HMO
MD408132300Medicaid
02YSOtherCAREFIRST - PROV/INQ#
09004OtherAMERIGROUP
RY4OtherCAREFIRST BLUECHOICE
=========OtherCOVENTRY
71-00181OtherUNITED - EVERCARE
=========OtherCIGNA - MID-ATLANTIC
=========OtherHNFS-TRICARE
=========OtherJOHNS HOPKINS
=========OtherNATIONAL CAPITAL PPO
RY4OtherCAREFIRST BLUECHOICE
=========OtherCAREFIRST - TIN
=========OtherMARYLAND PHYSICIAN CARE
RY4OtherCAREFIRST - IND/PPO