Provider Demographics
NPI:1790746444
Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.
Entity Type:Organization
Organization Name:ST. MARY'S HOSPITAL OF ST. MARY'S COUNTY, INC.
Other - Org Name:HOSPICE OF ST. MARY'S
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-503-8720
Mailing Address - Street 1:44724 HOSPICE LANE
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:MD
Mailing Address - Zip Code:20620
Mailing Address - Country:US
Mailing Address - Phone:301-994-3023
Mailing Address - Fax:301-475-6188
Practice Address - Street 1:44724 HOSPICE LANE
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:MD
Practice Address - Zip Code:20620
Practice Address - Country:US
Practice Address - Phone:301-994-3023
Practice Address - Fax:301-475-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1539251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD600902603Medicaid
MD600902603Medicaid