Provider Demographics
NPI:1013145473
Name:HILLCREST SCHOOL BASED HEALTH CENTER
Entity Type:Organization
Organization Name:HILLCREST SCHOOL BASED HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RAMENTA
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-600-3955
Mailing Address - Street 1:100 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5527
Mailing Address - Country:US
Mailing Address - Phone:301-600-1506
Mailing Address - Fax:
Practice Address - Street 1:1285 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-1396
Practice Address - Country:US
Practice Address - Phone:240-236-3275
Practice Address - Fax:240-236-3293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF FREDERICK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-24
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200175600Medicaid