Provider Demographics
NPI:1174832620
Name:CAROLINE CO. HEALTH DEPT. HIV CASE MANAGEMENT
Entity Type:Organization
Organization Name:CAROLINE CO. HEALTH DEPT. HIV CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-479-8036
Mailing Address - Street 1:403 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1327
Mailing Address - Country:US
Mailing Address - Phone:410-479-8036
Mailing Address - Fax:410-479-0554
Practice Address - Street 1:403 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1327
Practice Address - Country:US
Practice Address - Phone:410-479-8036
Practice Address - Fax:410-479-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027046251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD273143600Medicaid