Provider Demographics
NPI:1003968991
Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:ALLEGANY COUNTY HEALTH DEPARTMENT
Other - Org Name:ACHD-OUTPATIENT ADDICTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:301-759-5001
Mailing Address - Street 1:PO BOX 1745
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1745
Mailing Address - Country:US
Mailing Address - Phone:301-759-5000
Mailing Address - Fax:301-777-5674
Practice Address - Street 1:12501-12503 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-759-5050
Practice Address - Fax:301-777-2098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLEGANY COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-18
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903069251S00000X
MD903070251S00000X
MD903068261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
351541OtherMAMSI
KOOtherMAGELLAN
323817OtherVALUE OPTIONS
MD702001500Medicaid
O2KOOtherMAGELLAN
8480502OtherUBH (MCO)
55752NOOtherPRIORITY PARTNERS (MCO)
604116-04OtherCAREFIRST BCBS
NU1OtherGHMSI
1059446OtherCIGNA
MD702001500Medicaid