Provider Demographics
NPI:1184627234
Name:CHESAPEAKE-POTOMAC HOME HEALTH AGENCY, INC
Entity type:Organization
Organization Name:CHESAPEAKE-POTOMAC HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-274-9000
Mailing Address - Street 1:7627 LEONARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20637-3005
Mailing Address - Country:US
Mailing Address - Phone:301-274-9000
Mailing Address - Fax:301-274-4731
Practice Address - Street 1:7627 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:MD
Practice Address - Zip Code:20637-3005
Practice Address - Country:US
Practice Address - Phone:301-274-9000
Practice Address - Fax:301-274-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7138251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404458400Medicaid
MD02YYOtherBCBS
MD995500300Medicaid
MDMG2OtherBCBS FED, XIP, XIC, XIA
MD58365401OtherBCBS NASCO, XW
MD58365401OtherBCBS NASCO, XW