Basic Information
| Provider Information | |||||||||
| NPI: | 1073569653 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COLLEGE VIEW CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLLEGE VIEW CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | KENNETT SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193483109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109254436 | ||||||||
| FaxNumber: | 6109254351 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 TOLL HOUSE AVE | ||||||||
| Address2: | |||||||||
| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217014575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016635181 | ||||||||
| FaxNumber: | 3016633950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | DROPESKEY | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6109254231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 10-002 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 08833 | 01 | AMERIGROUP | OTHER | RY2 | 01 | CAREFIRST-IND/PPO | OTHER | RY2 | 01 | CAREFIRST-BLUE-CHOICE | OTHER | 02Y9 | 01 | CAREFIRST-PROV/INQ# | OTHER | 1076920 | 01 | AETNA-HMO | OTHER | 71-00315 | 01 | UNITED - EVERCARE | OTHER | 345101 | 01 | UNITED - MAMSI | OTHER | 408134000 | 05 | MD | MEDICAID |