Provider Demographics
NPI:1295246718
Name:SAFE HARBOR BEHAVIORAL CARE CHESAPEAKE LLC
Entity type:Organization
Organization Name:SAFE HARBOR BEHAVIORAL CARE CHESAPEAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-807-2626
Mailing Address - Street 1:946 NABBS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8434
Mailing Address - Country:US
Mailing Address - Phone:410-807-2626
Mailing Address - Fax:
Practice Address - Street 1:108 OLD SOLOMONS ISLAND RD UNIT 5
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3845
Practice Address - Country:US
Practice Address - Phone:410-807-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty