Collaboration Agreement No:
2341
Confirmation No:
2341_1395C0006083
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Nursing Home/Long Term Care Facility
Facility
Collingswood Rehabilitation And Healthcare Center
Address
299 Hurley Avenue
Rockville
MD 20850
Is this the location where a copy of your collaboration agreement is on file? NO
A copy (paper or electronic) must be immediately available upon request by the Board.
Location: 1205 York Road, Suite 11, Timonium, MD, 21093
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
YES
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO