515 Brightfield Road Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

03-017 Issued in MD

Legal business name

515 BRIGHTFIELD ROAD OPERATIONS LLC

Doing business as

PowerBack Rehabilitation Brightwood Campus

Practice address

515 Brightfield Rd
Lutherville, MD 21093-3643

Phone

(410) 296-1990

Fax

(410) 321-4936

NPI assigned

Nov 27, 2007

Organization subpart

No

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

Authorized official

Name

Michael T. Berg

Title

Assistant Secretary

Phone

(505) 468-4752

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PowerBack Rehabilitation Brightwood Campus Doing business as

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

{
    "created_epoch": "1196121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452211200000",
    "number": "1710169271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE ST",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "610-925-4436",
            "fax_number": "610-925-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 BRIGHTFIELD RD",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210933643",
            "telephone_number": "410-296-1990",
            "fax_number": "410-321-4936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "515 BRIGHTFIELD ROAD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-27",
        "last_updated": "2016-01-08",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "505-468-4752"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MD",
            "license": "03-017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413979800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PowerBack Rehabilitation Brightwood Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 515 Brightfield Road Opco LLC
• 515 Brightfield Road Operations LLC (PowerBack Rehabilitation, Brightwood Campus)
• A Better Living Wellness Center
• Ihsan Abdul Jabbar, PTA
• Shahab Naheed Abidi, MD
• Ariella Abraham, PSY.D.

• Skilled Nursing Facility in Lutherville, MD
• Providers in Lutherville, 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 Jan 8, 2016; 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.