Crofton Convalescent Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

02-011 Issued in MD

Legal business name

CROFTON CONVALESCENT CENTER, INC.

Practice address

2131 Davidsonville Rd
Crofton, MD 21114-1632

Phone

(410) 721-1000

Fax

(410) 721-2749

NPI assigned

Mar 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Philip J Gordon

Title

Nursing Home Administrator

Phone

(410) 721-1000

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1093782468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 DAVIDSONVILLE RD",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141632",
            "telephone_number": "410-721-1000",
            "fax_number": "410-721-2749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2131 DAVIDSONVILLE RD",
            "city": "CROFTON",
            "state": "MD",
            "postal_code": "211141632",
            "telephone_number": "410-721-1000",
            "fax_number": "410-721-2749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROFTON CONVALESCENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-03",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "410-721-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "02-011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021797200",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Crofton, MD
• Providers in Crofton, MD by specialty
• Skilled Nursing Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.