Provider Demographics
NPI:1679842462
Name:GARRETT COUNTY PERSONAL HEALTH
Entity type:Organization
Organization Name:GARRETT COUNTY PERSONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-334-7703
Mailing Address - Street 1:1025 MEMORIAL DR
Mailing Address - Street 2:1025 MEMORIAL DRIVE
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4343
Mailing Address - Country:US
Mailing Address - Phone:301-334-7700
Mailing Address - Fax:301-334-7717
Practice Address - Street 1:1025 MEMORIAL DR
Practice Address - Street 2:1025 MEMORIAL DRIVE
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4343
Practice Address - Country:US
Practice Address - Phone:301-334-7700
Practice Address - Fax:301-334-7717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARRETT COUNTY HEALTH DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-22
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSTATE AGENCY251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420919200Medicaid