Provider Demographics
NPI:1952512071
Name:HOSPICE OF CHARLES COUNTY INC
Entity Type:Organization
Organization Name:HOSPICE OF CHARLES COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-861-5305
Mailing Address - Street 1:2505 DAVIS ROAD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3806
Mailing Address - Country:US
Mailing Address - Phone:301-861-5300
Mailing Address - Fax:301-861-5317
Practice Address - Street 1:2505 DAVIS ROAD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3806
Practice Address - Country:US
Practice Address - Phone:301-861-5300
Practice Address - Fax:301-861-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1519251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD754851600Medicaid