205 Armstrong Avenue Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

17-001 Issued in MD

Legal business name

205 ARMSTRONG AVENUE OPERATIONS LLC

Practice address

205 Armstrong St
Centreville, MD 21617-2125

Phone

(410) 758-2323

Fax

(410) 758-4755

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

• Corsica Hills Center 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": "1982886446",
    "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": "205 ARMSTRONG ST",
            "city": "CENTREVILLE",
            "state": "MD",
            "postal_code": "216172125",
            "telephone_number": "410-758-2323",
            "fax_number": "410-758-4755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "205 ARMSTRONG AVENUE 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": "17-001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "413984400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corsica Hills Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 205 Armstrong Avenue Operations LLC
• Absolute Health and Wellness
• Farooq Adetola
• Lisa Lister Adkins, CRNP
• Advita Health LLC
• Affiliated Sante Group

• Skilled Nursing Facility in Centreville, MD
• Providers in Centreville, 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.