Basic Information
| Provider Information | |||||||||
| NPI: | 1821528332 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1745 | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215011745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017595000 | ||||||||
| FaxNumber: | 3017775674 | ||||||||
| Practice Location | |||||||||
| Address1: | 10102 COUNTRY CLUB RD SE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017772285 | ||||||||
| FaxNumber: | 3017775832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2017 | ||||||||
| LastUpdateDate: | 06/16/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MAYER | ||||||||
| AuthorizedOfficialFirstName: | JENELLE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ALLEGANY COUNTY HEALTH OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3017595000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALLEGANY COUNTY HEALTH DEPARTMENT | ||||||||
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| AuthorizedOfficialCredential: | M.P.H. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | BH000023 | MD | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.