NPIMap

Organization Active NPI

Cherry Lane Medical Investors LLC

  • Skilled Nursing Facility
  • Laurel, MD
National Provider Identifier
1124074620
Registry record updated Dec 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
16-033 Issued in MD
Legal business name
CHERRY LANE MEDICAL INVESTORS LLC
Practice address
9001 Cherry LN
Laurel, MD 20708-1155
Phone
(301) 498-8558
Fax
(301) 317-1930
NPI assigned
May 26, 2006
Organization subpart
Yes
Parent organization
FG HEALTHCARE PROPERTYS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2009

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

Authorized official

Name
Mr. Tim Beaulieu
Title
Owner
Phone
(404) 876-3836

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 16-033 MD Primary

Addresses

Primary practice location

9001 Cherry LN
Laurel, MD 20708-1155

Mailing address

9001 Cherry LN
Laurel, MD 20708-1155
Phone (301) 498-8558

Other identifiers 1

IdentifierTypeStateIssuer
367300600MedicaidMH

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261526400000",
    "number": "1124074620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9001 CHERRY LN",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207081155",
            "telephone_number": "301-498-8558",
            "fax_number": "301-317-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 CHERRY LN",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207081155",
            "telephone_number": "301-498-8558",
            "fax_number": "301-317-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRY LANE MEDICAL INVESTORS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FG HEALTHCARE PROPERTYS, LLC",
        "enumeration_date": "2006-05-26",
        "last_updated": "2009-12-23",
        "status": "A",
        "authorized_official_last_name": "BEAULIEU",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-876-3836",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "16-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "367300600",
            "state": "MH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2009; 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.