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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS MICHELLE WIKE BON, RN (CEO)
(410) 486-8650
Entity
Organization

Contact information

Practice address
1726 REISTERSTOWN RD, SUITE 205, PIKESVILLE, MD 21208-2974
(410) 486-8650
(410) 486-6935
Mailing address
1726 REISTERSTOWN RD, SUITE 205, PIKESVILLE, MD 21208-2974
(410) 486-8650
(410) 486-6935

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30AL2588
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
341402700
MD
Enumeration date
02/08/2007
Last updated
08/22/2020
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