Provider Demographics
NPI:1053926741
Name:PASS MARYLAND INC
Entity type:Organization
Organization Name:PASS MARYLAND INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-470-6041
Mailing Address - Street 1:64 LANDMARK CT
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3042
Mailing Address - Country:US
Mailing Address - Phone:443-470-6041
Mailing Address - Fax:
Practice Address - Street 1:64 LANDMARK CT
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3042
Practice Address - Country:US
Practice Address - Phone:443-470-6041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty