Provider Demographics
NPI:1376589309
Name:CHASE BREXTON HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CHASE BREXTON HEALTH SERVICES, INC.
Other - Org Name:CHASE BREXTON HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-837-2050
Mailing Address - Street 1:1111 NORTH CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:410-752-1374
Practice Address - Street 1:5500 KNOLL NORTH DR
Practice Address - Street 2:STE 370
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2209
Practice Address - Country:US
Practice Address - Phone:410-884-7831
Practice Address - Fax:410-715-3734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MDK802Medicare PIN
K802Medicare UPIN
211855Medicare Oscar/Certification
MD132190100Medicaid