Provider Demographics
NPI:1588724538
Name:ANNAPOLIS HERITAGE PARTNERS, LLC
Entity type:Organization
Organization Name:ANNAPOLIS HERITAGE PARTNERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-796-8273
Mailing Address - Street 1:400 CENTRE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458
Mailing Address - Country:US
Mailing Address - Phone:617-796-8160
Mailing Address - Fax:617-796-8375
Practice Address - Street 1:2717 RIVA ROAD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-7300
Practice Address - Fax:410-224-5732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNAPOLIS HERITAGE PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15958310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD530907700Medicaid