1221 Waugh Chapel Opco LLC
Skilled Nursing Facility in Gambrills, MD. Organization (NPI-2).
NPI number1912583683
StatusActive
Last updated in NPPESMar 22, 2021
Details
- NPI
- 1912583683
- Entity type
- Organization (NPI-2)
- Legal business name
- 1221 Waugh Chapel Opco LLC
- Organization subpart
- No
- Enumeration date
- Mar 22, 2021
- Certification date
- Mar 22, 2021
- Last updated
- Mar 22, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
| 313M00000X | Nursing Facility/Intermediate Care Facility | – | – | |
| 385H00000X | Respite Care | – | – |
Other names
- Autumn Lake Healthcare At Waugh Chapel (Doing Business As)
Practice location
1221 Waugh Chapel RdGambrills, MD 21054-1608
Phone 877-567-0402
Mailing address
14c 53rd StBrooklyn, NY 11232-2644
Authorized official
Sam Stern
Cfo
8775670402
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