Organization
6000 BELLONA AVENUE OPERATIONS LLC
Active
Other names
Homewood Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
6000 BELLONA AVE, BALTIMORE, MD 21212-2922
(410) 323-4223
Mailing address
6000 BELLONA AVE, BALTIMORE, MD 21212-2922
(410) 323-4223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
30016
MD
225X00000X
Occupational Therapist
30016
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
445516900
—
MD
Enumeration date
04/21/2016
Last updated
08/31/2017
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