Provider Demographics
NPI:1437557220
Name:SHORE HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:SHORE HEALTH SYSTEM, INC.
Other - Org Name:SHORE BEHAVORIAL SUBSTANCE ABUSE IOP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-822-1000
Mailing Address - Street 1:219 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2913
Mailing Address - Country:US
Mailing Address - Phone:410-822-1000
Mailing Address - Fax:
Practice Address - Street 1:219 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2913
Practice Address - Country:US
Practice Address - Phone:410-822-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MARYLAND SHORE REGIONAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423225900Medicaid