Charleston Grove, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

08AL0144-A Issued in MD

Legal business name

CHARLESTON GROVE, LLC

Doing business as

The Charleston Senior Community

Practice address

45 Saint Patricks Dr
Waldorf, MD 20603-4507

Phone

(240) 270-7500

Fax

(240) 523-7410

NPI assigned

Apr 19, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Patrick Goff

Title

Executive Director

Phone

(240) 270-7500

Specialties & licenses 1

Addresses

Other names 1

• The Charleston Senior Community Doing business as

Locations

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1336673177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 SAINT PATRICKS DR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034507",
            "telephone_number": "240-270-7500",
            "fax_number": "240-523-7410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 SAINT PATRICKS DR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034507",
            "telephone_number": "240-270-7500",
            "fax_number": "240-523-7410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON GROVE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-19",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "240-270-7500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "08AL0144-A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Charleston Senior Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Waldorf, MD
• Providers in Waldorf, MD by specialty
• Assisted Living Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.