Organization
DIAKON LUTHERAN SENIOR LIVING - MARYLAND LLC
Active
Other names
Ravenwood Lutheran Village
Organization subpart
No
Provider details
NPI number
Authorized official
JARROD LEO (SENIOR VP, FINANCIAL PLANNING & OPE)
(717) 795-0364
Entity
Organization
Contact information
Practice address
1183 LUTHER DR, HAGERSTOWN, MD 21740-7407
(240) 420-4133
(240) 420-4218
Mailing address
1022 NORTH UNION STREET, MIDDLETOWN, PA 17057-2158
(717) 795-0386
(717) 795-0353
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
21010
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2175479P0005
—
MD
05
—
421699700
—
MD
05
—
7563001P0002
—
MD
Enumeration date
04/27/2006
Last updated
04/10/2019
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