Provider Demographics
NPI:1336145127
Name:FREDERICK HEALTH HOSPITAL INC
Entity Type:Organization
Organization Name:FREDERICK HEALTH HOSPITAL INC
Other - Org Name:FMH ROSE HILL REHAB, MT. AIRY REHAB, CRESTWOOD REHAB. MT. AIRY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-721-4452
Mailing Address - Street 1:400 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4506
Mailing Address - Country:US
Mailing Address - Phone:240-566-3330
Mailing Address - Fax:240-566-4872
Practice Address - Street 1:163 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4673
Practice Address - Country:US
Practice Address - Phone:240-566-3132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICK HEALTH HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1214175, 2381075OtherUNITED
MD232098301Medicaid
2609019, 2792129OtherAETNA PVN
KP73OtherCAREFIRST BCBS MARYLAND
W581OtherCAREFIRST BCBS GHMSI
2137788, 2137790OtherUNITED MAMSI
MD219298101Medicaid
484600, 524510OtherNCPPO
MD216637Medicare Oscar/Certification