Organization
AVALON HOME, INC.
Active
Other names
Avalon Manor Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE KEPHART (BUSINESS OFFICE MANAGER)
(301) 733-8700
Entity
Organization
Contact information
Practice address
14014 MARSH PIKE, HAGERSTOWN, MD 21742-1638
(301) 733-8700
(301) 733-8700
Mailing address
14014 MARSH PIKE, HAGERSTOWN, MD 21742-1638
(301) 733-8700
(301) 733-8700
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
21-001
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02MM
CAREFIRST - PROV INQ#
—
01
—
278161
AMERIGROUP
—
01
—
5522258
AETNA-HMO
—
01
—
RT3
CAREFIRST - BLUE CHOICE
—
Enumeration date
05/23/2006
Last updated
05/19/2022
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