Provider Demographics
NPI:1225564503
Name:ANNE ARUNDEL COUNTY DEPT OF HEALTH
Entity Type:Organization
Organization Name:ANNE ARUNDEL COUNTY DEPT OF HEALTH
Other - Org Name:SC MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPUTY HEALTH OFFICER, OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURESKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-222-7377
Mailing Address - Street 1:839 BESTGATE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3472
Mailing Address - Country:US
Mailing Address - Phone:410-222-6001
Mailing Address - Fax:410-222-7348
Practice Address - Street 1:839 BESTGATE RD
Practice Address - Street 2:STE 300
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3472
Practice Address - Country:US
Practice Address - Phone:410-222-6001
Practice Address - Fax:410-222-7348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health