Provider Demographics
NPI:1790820579
Name:THE BENEDICTINE SCHOOL FOR EXCEPTIONAL CHILREN, INC.
Entity Type:Organization
Organization Name:THE BENEDICTINE SCHOOL FOR EXCEPTIONAL CHILREN, INC.
Other - Org Name:BENEDICTINE PROGRAM AND SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-634-2112
Mailing Address - Street 1:14299 BENEDICTINE LN
Mailing Address - Street 2:
Mailing Address - City:RIDGELY
Mailing Address - State:MD
Mailing Address - Zip Code:21660-1434
Mailing Address - Country:US
Mailing Address - Phone:410-634-2112
Mailing Address - Fax:410-634-1223
Practice Address - Street 1:14299 BENEDICTINE LN
Practice Address - Street 2:
Practice Address - City:RIDGELY
Practice Address - State:MD
Practice Address - Zip Code:21660-1434
Practice Address - Country:US
Practice Address - Phone:410-634-2112
Practice Address - Fax:410-634-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541778300Medicaid
MD273701900Medicaid