Provider Demographics
NPI:1154455897
Name:CHESTER RIVER HOME CARE AND HOSPICE
Entity Type:Organization
Organization Name:CHESTER RIVER HOME CARE AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARINELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-778-7668
Mailing Address - Street 1:6602 CHURCH HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-2310
Mailing Address - Country:US
Mailing Address - Phone:410-778-1049
Mailing Address - Fax:410-778-7399
Practice Address - Street 1:6602 CHURCH HILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2310
Practice Address - Country:US
Practice Address - Phone:410-778-1049
Practice Address - Fax:410-778-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1504251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNY5OtherBLUE CROSS FEDERAL
MD104500803Medicaid
MD584128O1OtherBLUE CHOICE
MD104500803Medicaid