Organization
7520 SURRATTS ROAD OPERATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
7520 SURRATTS RD, CLINTON, MD 20735-3353
(301) 856-1600
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 925-4436
(610) 347-4099
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
16019
MD
314000000X
Skilled Nursing Facility
Primary
16-019
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102001300
—
MD
05
—
559802800
—
MD
Enumeration date
09/22/2010
Last updated
03/07/2018
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