Basic Information
| Provider Information | |||||||||
| NPI: | 1528172558 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE JOHNS HOPKINS HOSPITAL | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | THE JOHNS HOPKINS OUTPATIENT REHABILITATION FACILITY AT GREENSPRING | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 632051 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212632051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109559540 | ||||||||
| FaxNumber: | 4109550856 | ||||||||
| Practice Location | |||||||||
| Address1: | 10753 FALLS ROAD | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210934597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109559540 | ||||||||
| FaxNumber: | 4109550856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WERTHMAN | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, TREASURER,CFO, JHHS | ||||||||
| AuthorizedOfficialTelephone: | 4109556552 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOHNS HOPKINS HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 754210100 | 05 | MD | MEDICAID |