Organization
9701 MEDICAL CENTER DRIVE OPERATIONS LLC
Active
Other names
Shady Grove Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
9701 MEDICAL CENTER DR, ROCKVILLE, MD 20850-3326
(301) 315-1900
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 347-4099
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
15009
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158057400
—
MD
05
—
562108900
—
MD
Enumeration date
09/22/2010
Last updated
01/08/2016
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