Organization · NPI-2

115 East Melrose Avenue Operations LLC

Skilled Nursing Facility · Baltimore, MD

NPI number1487836953
StatusActive
Last updated in NPPESJan 8, 2016

Details

NPI
1487836953
Entity type
Organization (NPI-2)
Legal business name
115 East Melrose Avenue Operations LLC
Organization subpart
No
Enumeration date
Nov 27, 2007
Last updated
Jan 8, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
314000000X Skilled Nursing Facility30-044MDYes

Other names

  • Long Green Center (Doing Business As)

Practice location

115 E Melrose Ave
Baltimore, MD 21212-2945

Phone 410-435-9073 · Fax 410-435-6824

Mailing address

101 E State St
Kennett Square, PA 19348-3109

Phone 610-925-4436 · Fax 610-925-4351

Authorized official

Michael T. Berg
Assistant Secretary
5054684752

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