Organization
2131 DAVIDSONVILLE OPCO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM STERN (CFO)
(877) 567-0402
Entity
Organization
Contact information
Practice address
2131 DAVIDSONVILLE RD, CROFTON, MD 21114-1632
(877) 567-0402
Mailing address
14C 53RD ST STE 220, BROOKLYN, NY 11232-2644
(877) 567-0402
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
06/08/2021
Last updated
06/08/2021
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