1023235157 NPI number — ST. MARY'S COUNTY GOV'T, DEPT. OF AGING, MEDICAL ADULT DAY SERVICES

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 1023235157 NPI number — ST. MARY'S COUNTY GOV'T, DEPT. OF AGING, MEDICAL ADULT DAY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. MARY'S COUNTY GOV'T, DEPT. OF AGING, MEDICAL ADULT DAY SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1023235157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 653
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-0653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-475-4200
Provider Business Mailing Address Fax Number:
301-475-4503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24400 MERVELL DEAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20636-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-373-6515
Provider Business Practice Location Address Fax Number:
301-373-6517
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
LORI
Authorized Official Middle Name:
JENNINGS-
Authorized Official Title or Position:
DIRECTOR, DEPARTMENT OF AGING
Authorized Official Telephone Number:
301-475-4200

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , 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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