1336370410 NPI number — CHOPTANK COMMUNITY HEALTH SYSTEM, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336370410 NPI number — CHOPTANK COMMUNITY HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
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:
RIDGELY ELEMENTARY SCHOOL SBHC
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:
1336370410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21660-1345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
106-349-1534
Provider Business Mailing Address Fax Number:
833-914-0409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 N CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21660-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-634-9153
Provider Business Practice Location Address Fax Number:
833-914-0409
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RICH
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-479-4306

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 784381013 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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