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
(410) 435-6824
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 925-4351
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
30-044
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413969100
—
MD
Enumeration date
11/27/2007
Last updated
01/08/2016
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