Provider Demographics
NPI:1457307076
Name:KENT COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KENT COUNTY HEALTH DEPARTMENT
Other - Org Name:KENT COUNTY HEALTH DEPARTMENT/OMHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-5783
Mailing Address - Street 1:125 S LYNCHBURG ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1146
Mailing Address - Country:US
Mailing Address - Phone:410-778-1350
Mailing Address - Fax:410-778-6119
Practice Address - Street 1:300 SCHEELER RD
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-1014
Practice Address - Country:US
Practice Address - Phone:410-778-5783
Practice Address - Fax:446-400-7568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0027046251K00000X
MD15653251K00000X
MD15652251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408186200Medicaid
MD703751101Medicaid
MD703751101Medicaid
MD008FMedicare PIN
MD141PMedicare PIN