NPIMap

Organization Active NPI

Heron'S Creek

  • Assisted Living Facility
  • North East, MD
National Provider Identifier
1669743175
Registry record updated Jan 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL000682 Issued in MD
Legal business name
HERON'S CREEK
Practice address
112 Red Toad Rd
North East, MD 21901-2601
Phone
(443) 674-8745
NPI assigned
Jan 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2012

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

Authorized official

Name
Mrs. Doris Stacy Fair, PANPI 1659777225
Title
Manager
Phone
(443) 540-8949

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL000682 MD Primary

Addresses

Primary practice location

112 Red Toad Rd
North East, MD 21901-2601

Mailing address

137 Linton Run Rd
Port Deposit, MD 21904-1650
Phone (443) 540-8949

National Provider Directory

National Provider Directory

Locations

112 Red Toad Rd
North East, MD 21901
Phone (443) 674-8745

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326672000000",
    "number": "1669743175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "137 LINTON RUN RD",
            "city": "PORT DEPOSIT",
            "state": "MD",
            "postal_code": "219041650",
            "telephone_number": "443-540-8949",
            "fax_number": "410-378-4162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 RED TOAD RD",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219012601",
            "telephone_number": "443-674-8745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERON'S CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-16",
        "last_updated": "2012-01-16",
        "status": "A",
        "authorized_official_last_name": "FAIR",
        "authorized_official_first_name": "DORIS",
        "authorized_official_middle_name": "STACY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "443-540-8949",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MD",
            "license": "AL000682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North East, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.