CHARLESTON GROVE LLC NPI 1336673177

NPI Information

  • NPI: 1336673177
  • Provider Name: CHARLESTON GROVE, LLC
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: THE CHARLESTON SENIOR COMMUNITY
  • CLIA Number: 21D2107562
  • Address: 45 SAINT PATRICKS DR
    WALDORF, MD
    ZIP 20603
  • Phone: (240) 270-7500

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NPI Details

CHARLESTON GROVE, LLC is an assisted living facility in Waldorf, MD. The provider is 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. CHARLESTON GROVE, LLC NPI is 1336673177. The provider is registered as an organization entity type.
The provider Is Doing Business As The Charleston Senior Community.

The provider's business location address is:

45 SAINT PATRICKS DR
WALDORF, MD
ZIP 20603-507
Phone: (240) 270-7500
Fax: (240) 523-7410

The provider's authorized official is Patrick Goff .
The authorized official title is Executive Director and has the following contact phone number (240) 270-7500.

The CLIA number assigned to this NPI record is 21D2107562 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/19/2017 and was last updated on 4/19/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility08AL0144-AMARYLANDYes

What is NPI?

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This page was last updated on: 3/30/2025

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