Organization
SERENITY MANOR @GWYNN OAK CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAMILLE MATTHEWS (PRESIDENT)
(443) 801-3134
Entity
Organization
Contact information
Practice address
5216 GWYNN OAK AVE, BALTIMORE, MD 21207-6807
(443) 801-3134
Mailing address
5216 GWYNN OAK AVE, BALTIMORE, MD 21207-6807
(443) 801-3134
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30AL3565A
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467589242
—
MD
05
—
5795420101
—
MD
Enumeration date
07/06/2016
Last updated
07/06/2016
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