Provider Demographics
NPI:1245238336
Name:BALTIMORE COUNTY, MARYLAND
Entity Type:Organization
Organization Name:BALTIMORE COUNTY, MARYLAND
Other - Org Name:BALTIMORE COUNTY DEPARTMENT OF HEALTH - HOME HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, BUREAU OF LONG TERM CARE
Authorized Official - Prefix:
Authorized Official - First Name:DELLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-887-2789
Mailing Address - Street 1:6401 YORK RD
Mailing Address - Street 2:DRUMCASTLE CENTER 3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2152
Mailing Address - Country:US
Mailing Address - Phone:410-887-2725
Mailing Address - Fax:410-887-2785
Practice Address - Street 1:6401 YORK RD
Practice Address - Street 2:DRUMCASTLE CENTER 3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2152
Practice Address - Country:US
Practice Address - Phone:410-887-2725
Practice Address - Fax:410-887-2785
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE COUNTY, MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD58459501OtherCAREFIRST BC/BS
MD02SJOtherCAREFIRST BC/BS
MD410113800Medicaid
217027Medicare ID - Type Unspecified