Provider Demographics
NPI:1306842174
Name:FREDERICK HEALTH HOSPITAL INC
Entity Type:Organization
Organization Name:FREDERICK HEALTH HOSPITAL INC
Other - Org Name:FREDERICK HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVEVICE PRESIDENT AND CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-566-3355
Mailing Address - Street 1:PO BOX 1093
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0093
Mailing Address - Country:US
Mailing Address - Phone:240-566-3222
Mailing Address - Fax:240-566-3961
Practice Address - Street 1:1 FREDERICK HEALTH WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-9435
Practice Address - Country:US
Practice Address - Phone:240-566-3222
Practice Address - Fax:240-566-3033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK HEALTH HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-24
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7034251E00000X, 251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371350OtherUNITED
NI6-0001OtherCAREFIRST BCBS GHMSI
MD046063000Medicaid
2152028OtherAETNA PVN
2371350OtherUNITED
618032OtherNCPPO
NI6-0001OtherCAREFIRST BCBS GHMSI
BK14OtherCAREFIRST BCBS MARYLAND
MD046063000Medicaid