Provider Demographics
NPI:1114141785
Name:GARRETT COUNTY BOARD OF EDUCATION
Entity Type:Organization
Organization Name:GARRETT COUNTY BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-914-1351
Mailing Address - Street 1:40 S SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550
Mailing Address - Country:US
Mailing Address - Phone:301-334-8900
Mailing Address - Fax:301-334-7621
Practice Address - Street 1:40 S SECOND STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-8900
Practice Address - Fax:301-334-7621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541388500Medicaid