Provider Demographics
NPI:1215930003
Name:COLLINGSWOOD NURSING FACILITIES INC
Entity type:Organization
Organization Name:COLLINGSWOOD NURSING FACILITIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-762-8900
Mailing Address - Street 1:299 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3118
Mailing Address - Country:US
Mailing Address - Phone:301-762-8900
Mailing Address - Fax:301-762-8020
Practice Address - Street 1:299 HURLEY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3118
Practice Address - Country:US
Practice Address - Phone:301-762-8900
Practice Address - Fax:301-762-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02FVCOOtherBLUECROSS MARYLAND
RE6OtherBCBSNCA
7100090OtherEVERCARE PROVIDER NUMBER
MD155327500Medicaid
7100090OtherEVERCARE PROVIDER NUMBER