Provider Demographics
NPI:1285896209
Name:MRTLLC
Entity type:Organization
Organization Name:MRTLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-384-9540
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:SAVERNA PARK
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-8408
Mailing Address - Country:US
Mailing Address - Phone:410-384-9540
Mailing Address - Fax:410-384-9541
Practice Address - Street 1:118 ARUNDEL BEACH RD
Practice Address - Street 2:SAVERNA PARK
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3102
Practice Address - Country:US
Practice Address - Phone:410-384-9540
Practice Address - Fax:410-384-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02AL02333104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3106039000Medicaid