Provider Demographics
NPI:1124202940
Name:HCPSS INFANT AND TODDLER PROGRAM
Entity Type:Organization
Organization Name:HCPSS INFANT AND TODDLER PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLING ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-313-6708
Mailing Address - Street 1:8930 STANFORD BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5805
Mailing Address - Country:US
Mailing Address - Phone:410-313-6708
Mailing Address - Fax:
Practice Address - Street 1:8930 STANFORD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5805
Practice Address - Country:US
Practice Address - Phone:410-313-6708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOWARD COUNTY PUBLIC SCHOOL SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD096800500Medicaid