Provider Demographics
NPI:1942426911
Name:POTOMAC RIDGE BEHAVIOAL HEALTH ES
Entity Type:Organization
Organization Name:POTOMAC RIDGE BEHAVIOAL HEALTH ES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MISTRANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-221-0288
Mailing Address - Street 1:821 FIELDCREST RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-9423
Mailing Address - Country:US
Mailing Address - Phone:410-221-0288
Mailing Address - Fax:410-228-9588
Practice Address - Street 1:821 FIELDCREST RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-9423
Practice Address - Country:US
Practice Address - Phone:410-221-0288
Practice Address - Fax:410-228-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09-001281PC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281PC2000XHospitalsChronic Disease HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherUNITED BEHAVIORAL HEALTH
=========OtherVALUE OPTIONS