Provider Demographics
NPI:1982876736
Name:SPRINGWELL, LLC
Entity Type:Organization
Organization Name:SPRINGWELL, LLC
Other - Org Name:SPRINGWELL SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-771-9043
Mailing Address - Street 1:2211 W ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4424
Mailing Address - Country:US
Mailing Address - Phone:410-664-4006
Mailing Address - Fax:410-664-3060
Practice Address - Street 1:2211 W ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4424
Practice Address - Country:US
Practice Address - Phone:410-664-4006
Practice Address - Fax:410-664-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30AL3107-A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9518037 00Medicaid