1548261803 NPI number — CARENET HEALTH SYSTEMS & SERVICES, INC.

Table of content: (NPI 1669198156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548261803 NPI number — CARENET HEALTH SYSTEMS & SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARENET HEALTH SYSTEMS & SERVICES, 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:
LORIEN MT. AIRY
Provider Other Organization Name Type Code:
5
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:
1548261803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 MIDWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21771-2861
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-829-6050
Provider Business Mailing Address Fax Number:
301-829-9065

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 MIDWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT AIRY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21771-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-829-6050
Provider Business Practice Location Address Fax Number:
301-829-9065
Provider Enumeration Date:
08/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRIMMEL
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
410-750-7500

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  06021 , 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)

  • Identifier: 215370000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".