Organization
115 EAST MELROSE AVENUE OPERATIONS LLC
Active
Other names
Long Green Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
115 E MELROSE AVE, BALTIMORE, MD 21212-2945
(410) 435-9073
Mailing address
115 E MELROSE AVE, BALTIMORE, MD 21212-2945
(410) 435-9073
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
30044
MD
225X00000X
Occupational Therapist
30044
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442156600
—
MD
Enumeration date
04/21/2016
Last updated
09/07/2017
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