Provider Demographics
NPI:1477943108
Name:GARRETT COUNTY HEALTH DEPT-SUBSTANCE ABUSE
Entity Type:Organization
Organization Name:GARRETT COUNTY HEALTH DEPT-SUBSTANCE ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLOTFELTY
Authorized Official - Suffix:
Authorized Official - Credentials:RS, MPH
Authorized Official - Phone:301-334-7700
Mailing Address - Street 1:1025 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4343
Mailing Address - Country:US
Mailing Address - Phone:301-334-7670
Mailing Address - Fax:301-334-7671
Practice Address - Street 1:1025 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4343
Practice Address - Country:US
Practice Address - Phone:301-334-7670
Practice Address - Fax:301-334-7671
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARRETT COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904847251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD423207100Medicaid