Organization
AUGSBURG LUTHERAN HOME OF MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEROME DAVID POTTER (INFORMATION SYSTEMS MANAGER)
(443) 471-1004
Entity
Organization
Contact information
Practice address
6811 CAMPFIELD RD, BALTIMORE, MD 21207-4657
(410) 486-4573
(410) 653-8744
Mailing address
6811 CAMPFIELD RD, BALTIMORE, MD 21207-4657
(410) 486-4573
(410) 653-8744
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
03-003
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032087100
—
MD
01
—
71-00455
EVERCARE
MD
Enumeration date
07/05/2005
Last updated
10/24/2011
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