Provider Demographics
NPI:1578078531
Name:CHESAPEAKE TREATMENT SERVICES OCEAN CITY LLC
Entity Type:Organization
Organization Name:CHESAPEAKE TREATMENT SERVICES OCEAN CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-385-6764
Mailing Address - Street 1:4600 MONGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2697
Mailing Address - Country:US
Mailing Address - Phone:184-438-5676
Mailing Address - Fax:
Practice Address - Street 1:12417 OCEAN GTWY STE 7
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9522
Practice Address - Country:US
Practice Address - Phone:443-373-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102000261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone