CHARLESTON GROVE, LLC (NPI# 1336673177) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336673177 |
| Entity Type | Organization |
| Organization Name | CHARLESTON GROVE, LLC |
| Other Organization Name | THE CHARLESTON SENIOR COMMUNITY |
| Practice Address |
45 Saint Patricks Dr Waldorf MD 20603-4507 |
| Practice Telephone | 2402707500 |
| Practice Fax Number | 2405237410 |
| Mailing Telephone | 2402707500 |
| Mailing Fax Number | 2405237410 |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |
| Authorized Official Name | MR. PATRICK GOFF (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2402707500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 08AL0144-A | MD | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| The Charleston Senior Community | Doing Business As Name - Organization |
| Street Address |
45 SAINT PATRICKS DR |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-4507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356940761 | Angel Living, LLC | Assisted Living Facility | 3978 Old Washington Rd, Waldorf, MD 20602-3217 | 2020-10-19 |
| 1124632211 | Citadel Management Group Inc. | Assisted Living Facility | 5360 Woodgate Ln, Waldorf, MD 20601-4457 | 2020-09-04 |
| 1184251753 | Bayou Estates LLC | Assisted Living Facility | 12203 Holm Oak Dr, Waldorf, MD 20601-4524 | 2020-03-24 |
| 1134773237 | Doleta Micshaye Allen | Assisted Living Facility | 4018 Blackbird Ct, Waldorf, MD 20603-4642 | 2019-07-26 |
| 1801304365 | Safe Haven Assisted Living | Assisted Living Facility | 6310 Josephine Rd, Waldorf, MD 20601-3207 | 2018-01-18 |
| 1427322551 | Morningside House of St. Charles | Assisted Living Facility | 70 Village St, Waldorf, MD 20602-1838 | 2012-03-07 |
| 1801190947 | Fenwick Landing, LLC | Assisted Living Facility | 11665 Doolittle Dr, Waldorf, MD 20602-2898 | 2011-01-04 |
| 1235201187 | Waldorf Snf Operations LLC | Assisted Living Facility | 4140 Old Washington Highway, Waldorf, MD 20602 | 2006-11-15 |
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| 1700486032 | Comfort At Home Care, LLC | Assisted Living Facility | 4628 Marble Hall Rd, Baltimore, MD 21239-3937 | 2020-10-27 |
| 1073113338 | Casa Living Inc | Assisted Living Facility | 13809 Doctor Edelen Dr, Accokeek, MD 20607-3786 | 2020-10-27 |
| 1528667011 | Affluent Living Adult Care | Assisted Living Facility | 4106 Maine Ave, Gwynn Oak, MD 21207-7503 | 2020-10-26 |
| 1134728678 | First-class Caregivers, LLC | Assisted Living Facility | 7214 Willow Hill Dr, Capitol Heights, MD 20743-2671 | 2020-10-24 |
| 1740896182 | M&o Prestige Partnership LLC | Assisted Living Facility | 1805 Ashburton St, Baltimore, MD 21216-3538 | 2020-09-21 |
| 1497360986 | Merle Newkirk | Assisted Living Facility | 7606 Fox Hunt Ct, Clinton, MD 20735-3063 | 2020-09-10 |
| 1881209690 | Serenity Gardens Assisted Living LLC | Assisted Living Facility | 10829 Burbank Dr, Potomac, MD 20854-1557 | 2020-09-09 |
| 1700491560 | Evergreen Gardens Assisted Living | Assisted Living Facility | 10120 Stansfield Rd, Laurel, MD 20723-1738 | 2020-09-09 |
| 1922612563 | Tracie Shirrelle Gambrill | Assisted Living Facility | 3029 Windsor Ave, Baltimore, MD 21216-2751 | 2020-09-01 |
| 1710502224 | Creatus Adult Assisted Living, LLC | Assisted Living Facility | 13414 Marburg Ln, Upper Marlboro, MD 20772-4809 | 2020-06-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.