Provider Demographics
NPI:1730143991
Name:EMERALD HEALTH CENTER, INC
Entity Type:Organization
Organization Name:EMERALD HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:J E
Authorized Official - Last Name:CORREA-CASHDOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-833-0580
Mailing Address - Street 1:217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1213
Mailing Address - Country:US
Mailing Address - Phone:410-833-0580
Mailing Address - Fax:410-833-8604
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1213
Practice Address - Country:US
Practice Address - Phone:410-833-0580
Practice Address - Fax:410-833-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020136103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD247LOtherMC GROUP NUMBER
MDKA78EMOtherCAREFIRST BC/BS