Provider Demographics
NPI:1801027891
Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Other - Org Name:COLONEL RICHARDSON HIGH SCHOOL SBHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-479-4306
Mailing Address - Street 1:25320 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-2403
Mailing Address - Country:US
Mailing Address - Phone:410-754-0750
Mailing Address - Fax:833-914-0411
Practice Address - Street 1:25320 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632-2403
Practice Address - Country:US
Practice Address - Phone:410-754-0750
Practice Address - Fax:833-914-0411
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-07
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD784381012Medicaid