Provider Demographics
NPI:1497951032
Name:KENT COUNTY HEALTH DEPT.
Entity Type:Organization
Organization Name:KENT COUNTY HEALTH DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-778-6404
Mailing Address - Street 1:300 SCHEELER RD
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-1014
Mailing Address - Country:US
Mailing Address - Phone:410-778-6404
Mailing Address - Fax:410-778-5431
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:410-778-6404
Practice Address - Fax:410-778-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9026783245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD753715800Medicaid