Organization
HERON'S CREEK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS STACY FAIR PA (MANAGER)
(443) 540-8949
Entity
Organization
Contact information
Practice address
112 RED TOAD RD, NORTH EAST, MD 21901-2601
(443) 674-8745
Mailing address
137 LINTON RUN RD, PORT DEPOSIT, MD 21904-1650
(443) 540-8949
(410) 378-4162
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL000682
MD
Other
Enumeration date
01/16/2012
Last updated
01/16/2012
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