Organization
DENNETT ROAD MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY L HOLLER (VICE PRESIDENT CFO)
(301) 334-2111
Entity
Organization
Contact information
Practice address
1113 MARY DR, OAKLAND, MD 21550-1428
(301) 334-8700
(301) 334-8347
Mailing address
1113 MARY DR, OAKLAND, MD 21550-1428
(301) 334-8700
(301) 334-8347
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
11004
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59007301
CAREFIRST BCBS
—
01
—
MP2
FEDERAL BCBS
—
Enumeration date
09/30/2005
Last updated
08/22/2020
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