Organization
DIAKON LUTHERAN SENIOR LIVING-MARYLAND RAVENWOOD CAMPUS
Active
Other names
Ravenwood Lutheran Village Outpatient Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT SOWERS (REIMBURSEMENT MANAGER)
(717) 795-0377
Entity
Organization
Contact information
Practice address
19800 TRANQUILITY CIR, HAGERSTOWN, MD 21742-4042
(301) 790-1000
Mailing address
960 CENTURY DR, MECHANICSBURG, PA 17055-4374
(717) 795-0388
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
21-010
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217547900
—
MD
Enumeration date
09/09/2008
Last updated
01/17/2012
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