Provider Demographics
NPI:1619338225
Name:MT. WASHINGTON PEDIATRIC COMMUNITY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:MT. WASHINGTON PEDIATRIC COMMUNITY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-578-5163
Mailing Address - Street 1:1708 W ROGERS AVE
Mailing Address - Street 2:ATTN: FINANCE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4545
Mailing Address - Country:US
Mailing Address - Phone:410-578-5163
Mailing Address - Fax:
Practice Address - Street 1:138 INDUSTRY LN
Practice Address - Street 2:UNIT 5A
Practice Address - City:FOREST HILL
Practice Address - State:MD
Practice Address - Zip Code:21050-1741
Practice Address - Country:US
Practice Address - Phone:410-367-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty