Provider Demographics
NPI:1386829661
Name:ARUNDEL LODGE, INC
Entity Type:Organization
Organization Name:ARUNDEL LODGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-433-5929
Mailing Address - Street 1:2600 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1102
Mailing Address - Country:US
Mailing Address - Phone:443-433-5929
Mailing Address - Fax:410-841-6045
Practice Address - Street 1:337 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4736
Practice Address - Country:US
Practice Address - Phone:443-433-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARUNDEL LODGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health