Organization
700 TOLL HOUSE AVENUE OPERATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
347 BALLENGER CTR DR, FREDERICK, MD 21703-7095
(301) 663-5181
(301) 663-3950
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 347-4099
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
10002
MD
314000000X
Skilled Nursing Facility
Primary
10002
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420462000
—
MD
Enumeration date
02/11/2011
Last updated
03/07/2018
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