Organization
700 TOLL HOUSE AVENUE 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
347 BALLENGER CENTER DR, FREDERICK, MD 21703-7095
(301) 663-5181
Mailing address
347 BALLENGER CENTER DR, FREDERICK, MD 21703-7095
(301) 663-5181
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10002
MD
225X00000X
Occupational Therapist
10002
MD
235Z00000X
Speech-Language Pathologist
10002
MD
314000000X
Skilled Nursing Facility
Primary
10002
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332009000
—
MD
Enumeration date
04/21/2016
Last updated
03/08/2018
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