Provider Demographics
NPI:1306878871
Name:METRA HEALTH GREENMOUNT SERVICE CORP
Entity type:Organization
Organization Name:METRA HEALTH GREENMOUNT SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIROKBROD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-358-6644
Mailing Address - Street 1:3435 GREENMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2824
Mailing Address - Country:US
Mailing Address - Phone:410-235-3662
Mailing Address - Fax:
Practice Address - Street 1:3435 GREENMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2824
Practice Address - Country:US
Practice Address - Phone:410-235-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy