Provider Demographics
NPI:1144033481
Name:HEMLOCK MANOR LLC
Entity type:Organization
Organization Name:HEMLOCK MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:443-956-5465
Mailing Address - Street 1:2801 HEMLOCK AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1246
Mailing Address - Country:US
Mailing Address - Phone:410-323-5767
Mailing Address - Fax:410-323-5001
Practice Address - Street 1:2801 HEMLOCK AVE FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1246
Practice Address - Country:US
Practice Address - Phone:410-323-5002
Practice Address - Fax:410-323-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility