Provider Demographics
NPI:1568707081
Name:EFFECTIVE INTEGRATIVE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EFFECTIVE INTEGRATIVE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:HARDNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BCIM, DAAMLP
Authorized Official - Phone:410-729-2200
Mailing Address - Street 1:681 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1326
Mailing Address - Country:US
Mailing Address - Phone:410-729-4006
Mailing Address - Fax:410-729-3443
Practice Address - Street 1:681 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1326
Practice Address - Country:US
Practice Address - Phone:410-729-2200
Practice Address - Fax:410-729-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03540111N00000X
MDR161899164W00000X, 363L00000X
MDD24017208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBD59-0000OtherCAREFIRST/BCBS
MDBD59-0000OtherCAREFIRST/BCBS