Provider Demographics
NPI:1548234925
Name:ANNE ARUNDEL COUNTY DEPT OF HEALTH
Entity Type:Organization
Organization Name:ANNE ARUNDEL COUNTY DEPT OF HEALTH
Other - Org Name:ADULT ADDICTION CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-222-6001
Mailing Address - Street 1:122 LANGLEY ROAD NORTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060
Mailing Address - Country:US
Mailing Address - Phone:410-222-0100
Mailing Address - Fax:410-222-0116
Practice Address - Street 1:122 LANGLEY ROAD NORTH
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060
Practice Address - Country:US
Practice Address - Phone:410-222-0100
Practice Address - Fax:410-222-0116
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-14
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265521700Medicaid
MD750171400Medicaid