Provider Demographics
NPI:1164791687
Name:DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Other - Org Name:WESTERN MARYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIAKHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-767-6003
Mailing Address - Street 1:201 W PRESTON ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2301
Mailing Address - Country:US
Mailing Address - Phone:410-767-6062
Mailing Address - Fax:
Practice Address - Street 1:201 W PRESTON ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2301
Practice Address - Country:US
Practice Address - Phone:410-767-6062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD350027600282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD350027600OtherSKILLED NURSING FACILITY
MD352525200Medicaid