Active NPI
Maryland Baptist Aged Home of the United Baptist Missionary Conven
- Skilled Nursing Facility
- Baltimore, MD
National Provider Identifier
1841237997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 30-081
- Legal business name
- MARYLAND BAPTIST AGED HOME OF THE UNITED BAPTIST MISSIONARY CONVEN
- Practice address
- 2801 Rayner Ave
Baltimore, MD 21216-4628 - Phone
- (410) 624-3964
- NPI assigned
- May 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Lavern Jones
- Title
- Administrator
- Phone
- (410) 945-7650
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 30-081 | MD | Primary |
Addresses
Primary practice location
2801 Rayner Ave
Baltimore, MD 21216-4628
Mailing address
2801 Rayner Ave
Baltimore, MD 21216-4628
Phone (410) 624-3964
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 301187900 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130315000265 | MD | Part A Provider - Skilled Nursing Facility | 3173768355 | Practice locations: Baltimore, MD |
Skilled nursing facility certification: CCN 215360
- Legal name
- MARYLAND BAPTIST AGED HOME OF THE UNITED BAPTIST MISSIONARY CONVEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 21, 2013
- Last certification
- Jun 30, 2022
- Beds
- 29
- Ownership / control type
- Church Related
- Organization structure
- Corporation
- Incorporated
- Oct 10, 1920 in MD
- Enrollment address
- 2801 Rayner Ave
Baltimore, MD 21216-4628 - Nursing home name
- MARYLAND BAPTIST AGED HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Maryland Baptist Aged Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Church related
- Certified
- Aug 21, 2013
- Medicare certification status
- Active
- Certified beds
- 29
National Provider Directory
National Provider Directory- Tax ID family
- Maryland Baptist Aged Home
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Nursing Facility/Intermediate Care Facility
- Baltimore, MD
- NPI 1528122363
Ownership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Elmore E Warren | Corporate Officer | Jan 1, 2010 | 100% |
| Derrick C Dewitt | Corporate Officer | Sep 8, 2014 | 100% |
| W-2 Managing Employee | Sep 8, 2014 | 100% | |
| Cleveland Mason | Corporate Officer | Jul 1, 2014 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Parkville, MD
- NPI 1083682074
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336953600000",
"number": "1841237997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2801 RAYNER AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212164628",
"telephone_number": "410-624-3964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2801 RAYNER AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212164628",
"telephone_number": "410-624-3964"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARYLAND BAPTIST AGED HOME OF THE UNITED BAPTIST MISSIONARY CONVEN",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-31",
"last_updated": "2012-05-14",
"status": "A",
"authorized_official_last_name": "JONES",
"authorized_official_first_name": "LAVERN",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "410-945-7650",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MD",
"license": "30-081",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "301187900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Baltimore, MD
- Marybird Mobility
- Maryland and Virginia Phlebology PC
- Maryland Anesthesia Consortium, LLC
- Maryland Asthma and Allergy Center CHTD
- Maryland Baptist Aged Home
- Maryland Behavior LLC
- Maryland Behavioral Health Care LLC
- Maryland Behavioral Health Care LLC
- Maryland Behavioral Health Care LLC
- Maryland Care Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.