Provider Demographics
NPI:1417004698
Name:CAROLINE COUNTY HEALTH DEPT. MADC
Entity Type:Organization
Organization Name:CAROLINE COUNTY HEALTH DEPT. MADC
Other - Org Name:CAROLINE MEDICAL ADULT DAY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-479-8030
Mailing Address - Street 1:403 S 7TH ST
Mailing Address - Street 2:P.O. BOX 10
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1327
Mailing Address - Country:US
Mailing Address - Phone:410-479-8065
Mailing Address - Fax:410-479-4911
Practice Address - Street 1:403 S 7TH ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1327
Practice Address - Country:US
Practice Address - Phone:410-479-8065
Practice Address - Fax:410-479-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD502503600Medicaid