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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DENISE TILLMAN (ALM)
(410) 367-5521
Entity
Organization

Contact information

Practice address
4202 MAINE AVE, BALTIMORE, MD 21207-7505
(410) 367-5521
Mailing address
4202 MAINE AVE, BALTIMORE, MD 21207-7505

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
30AL2195
MD

Other

Enumeration date
06/03/2013
Last updated
06/03/2013
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