Provider Demographics
NPI:1831189042
Name:CALVERT COUNTY NURSING CENTER INC
Entity type:Organization
Organization Name:CALVERT COUNTY NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:YOUNGER
Authorized Official - Suffix:
Authorized Official - Credentials:R1595 NURSING HOME A
Authorized Official - Phone:410-535-2300
Mailing Address - Street 1:85 HOSPITAL ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4018
Mailing Address - Country:US
Mailing Address - Phone:410-535-2300
Mailing Address - Fax:410-535-1505
Practice Address - Street 1:85 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4018
Practice Address - Country:US
Practice Address - Phone:410-535-2300
Practice Address - Fax:410-535-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD314000000X314000000X
MD04-002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD043297100Medicaid
215188Medicare ID - Type Unspecified
MD215188Medicare Oscar/Certification