Organization Active NPI

Maryland Baptist Aged Home of the United Baptist Missionary Conven

  • Skilled Nursing Facility
  • Baltimore, MD
National Provider Identifier
1841237997
Registry record updated May 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
30-081 Issued in MD
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

Updated by the provider on May 14, 2012

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
301187900MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
CorporationNon-profit
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 HomeCCN 215360
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Aug 21, 2013
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
2924.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Maryland Baptist Aged Home2 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.

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.

NameRoleSinceShare
Elmore E Warren Individual Corporate OfficerChairman Trustee Board Jan 1, 2010 100%
Derrick C Dewitt Individual Corporate OfficerCfo Sep 8, 2014 100%
W-2 Managing EmployeeCfo Sep 8, 2014 100%
Cleveland Mason Individual Corporate OfficerPresident and Ceo 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.

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

Sources for this page

Verify at the official NPI Registry.