Provider Demographics
NPI:1750386082
Name:MGH COMMUNITY HEALTH, INC.
Entity type:Organization
Organization Name:MGH COMMUNITY HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-931-3100
Mailing Address - Street 1:4061 POWDER MILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CALVERTON
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3149
Mailing Address - Country:US
Mailing Address - Phone:301-931-3100
Mailing Address - Fax:301-931-8580
Practice Address - Street 1:17735 GEORGIA AVE
Practice Address - Street 2:STE 010
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2276
Practice Address - Country:US
Practice Address - Phone:301-570-7400
Practice Address - Fax:301-570-7420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDSTAR VNA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1084251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD826OtherCAREFIRST BCBS
MD472363500Medicaid
MD217118OtherEIN
MD59012601OtherCAREFIRST BCBS MD
MD217118Medicare Oscar/Certification