King David at Autumn Lake LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

KING DAVID AT AUTUMN LAKE LLC

Doing business as

King David Nursing and Rehabilitation Center

Practice address

4204 Old Milford Mill Rd
Pikesville, MD 21208-6031

Phone

(410) 486-1500

NPI assigned

Oct 24, 2018

Organization subpart

No

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

Authorized official

Name

Sam Stern

Title

Cfo

Phone

(718) 567-0400

Specialties & licenses 1

Addresses

Other names 1

• King David Nursing and Rehabilitation Center Doing business as

Tax ID family

King David at Autumn Lake LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• King David at Autumn Lake LLC

  dba King David Nursing and Rehabilitation Center

  • Skilled Nursing Facility
  • Baltimore, MD
  • NPI 1437693785
  NPD tax ID

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

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540339200000",
    "number": "1497222830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14C 53RD ST STE 220",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112322644",
            "telephone_number": "718-567-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 OLD MILFORD MILL RD",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212086031",
            "telephone_number": "410-486-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING DAVID AT AUTUMN LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2018-10-24",
        "status": "A",
        "authorized_official_last_name": "STERN",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-567-0400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King David Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nia Kerr
• Keystone Nursing Services LLC
• Nida Khan, OTR/L
• Armeen Khimani, PHARM D
• Bryan K Kihara
• Shyann King-Blowe
• Antoinette King
• Kerry King
• Marquisha King
• Ronald Allen King Jr.

• Skilled Nursing Facility in Pikesville, MD
• Providers in Pikesville, 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 Oct 24, 2018; 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.