Provider Demographics
NPI:1871793877
Name:NICHOLS SHELTER HOME FOR ELDERLY
Entity type:Organization
Organization Name:NICHOLS SHELTER HOME FOR ELDERLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:CAREGIVERF
Authorized Official - Phone:410-676-3374
Mailing Address - Street 1:1111 HANSON RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2116
Mailing Address - Country:US
Mailing Address - Phone:410-676-3374
Mailing Address - Fax:410-676-4980
Practice Address - Street 1:1111 HANSON RD.
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040
Practice Address - Country:US
Practice Address - Phone:410-676-3374
Practice Address - Fax:410-676-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12AL045302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization