THE CARE GROUP AT SAFE HARBOR, LLC

Provider Demographics

• NPI: 1629471958
• Name: THE CARE GROUP AT SAFE HARBOR, LLC
• Entity Type: Organization
• Organization Name: THE CARE GROUP AT SAFE HARBOR, LLC
• Authorized Official - Title/Position: CREDENTIALING COORDINATOR
• Authorized Official - First Name: STACI
• Authorized Official - Middle Name: N
• Authorized Official - Last Name: SCOGGIN
• Authorized Official - Phone: 410-893-4600
• Mailing Address - Street 1: 1208 E. CHURCHVILLE ROAD
• Mailing Address - Street 2: SUITE 300
• Mailing Address - City: BEL AIR
• Mailing Address - State: MD
• Mailing Address - Zip Code: 21014
• Mailing Address - Country: US
• Mailing Address - Phone: 410-893-4600
• Mailing Address - Fax: 443-640-4358
• Practice Address - Street 1: 1208 E CHURCHVILLE RD
• Practice Address - Street 2: STE 300
• Practice Address - City: BEL AIR
• Practice Address - State: MD
• Practice Address - Zip Code: 21014-3442
• Practice Address - Country: US
• Practice Address - Phone: 410-893-4600
• Practice Address - Fax: 443-640-4358
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2014-10-01
• Last Update Date: 2017-03-08

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NH	3102809	Medicaid
DE	003403098	Medicaid
IN	20280710	Medicaid
TN	Q014476	Medicaid
PA	103054509	Medicaid
MD	387081	Other	MEDICARE PTAN
OR	500701703	Medicaid
MD	783706200	Medicaid