1043290448 NPI number — CALVERT COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1043290448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043290448 NPI number — CALVERT COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVERT COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALVERT COUNTY BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043290448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-535-3079
Provider Business Mailing Address Fax Number:
410-535-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11845 HG TRUEMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUSBY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20657-2855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-394-0681
Provider Business Practice Location Address Fax Number:
410-326-1860
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
DORIS
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
BEHAVIORAL HEALTH DIRECTOR
Authorized Official Telephone Number:
410-535-3079

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  12083 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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