Provider Demographics
NPI:1023007820
Name:GARRETT COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GARRETT COUNTY MEMORIAL HOSPITAL
Other - Org Name:SUB-ACUTE REHAB UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:301-533-4171
Mailing Address - Street 1:251 N FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1375
Mailing Address - Country:US
Mailing Address - Phone:301-533-4220
Mailing Address - Fax:301-533-4208
Practice Address - Street 1:251 N FOURTH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1375
Practice Address - Country:US
Practice Address - Phone:301-533-4220
Practice Address - Fax:301-533-4208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARRETT COUNTY MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-14
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD110005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD155060800Medicaid