Basic Information
| Provider Information | |||||||||
| NPI: | 1114924115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LONG VIEW NURSING HOME, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3332 MAIN ST | ||||||||
| Address2: | POB 390 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211020390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102397139 | ||||||||
| FaxNumber: | 4102396460 | ||||||||
| Practice Location | |||||||||
| Address1: | 3332 MAIN ST | ||||||||
| Address2: | POB 390 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211020390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102397139 | ||||||||
| FaxNumber: | 4102396460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4102397139 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 06-006 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 59016801 | 01 | MD | BC/BS | OTHER |