Provider Demographics
NPI:1902806268
Name:XAVIER-KENSINGTON,LLC
Entity Type:Organization
Organization Name:XAVIER-KENSINGTON,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-933-0060
Mailing Address - Street 1:3000 MCCOMAS AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2316
Mailing Address - Country:US
Mailing Address - Phone:301-933-0060
Mailing Address - Fax:301-933-4884
Practice Address - Street 1:3000 MCCOMAS AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2316
Practice Address - Country:US
Practice Address - Phone:301-933-0060
Practice Address - Fax:301-933-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7100628OtherEVERCARE
MD215043Medicare ID - Type Unspecified