Provider Demographics
NPI:1871288399
Name:LILLY'S PLACE
Entity type:Organization
Organization Name:LILLY'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-903-7932
Mailing Address - Street 1:228 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3799
Mailing Address - Country:US
Mailing Address - Phone:410-903-7932
Mailing Address - Fax:410-510-1374
Practice Address - Street 1:228 FERNDALE RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3799
Practice Address - Country:US
Practice Address - Phone:410-903-7932
Practice Address - Fax:410-510-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility