Organization
CARROLL LUTHERAN VILLAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEARY MILLIKEN (CEO / PRESIDENT)
(410) 848-0090
Entity
Organization
Contact information
Practice address
300 SAINT LUKE CIR, WESTMINSTER, MD 21158-4174
(410) 848-0090
(410) 848-8133
Mailing address
300 SAINT LUKE CIR, WESTMINSTER, MD 21158-4174
(410) 848-0090
(410) 848-8133
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
06-012
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063417400
—
MD
01
—
57596102
CAREFIRST
MD
01
—
MP7
FEDERAL BLUE CROSS
MD
Enumeration date
08/13/2006
Last updated
11/03/2011
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