Organization
9109 LIBERTY ROAD OPERATIONS LLC
Active
Other names
Patapsco Valley Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
9109 LIBERTY RD, RANDALLSTOWN, MD 21133-3521
(410) 655-7373
(410) 655-0579
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 347-4099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
03031
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420460300
—
MD
Enumeration date
02/11/2011
Last updated
01/08/2016
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