MEDICARE: CHASE BREXTON HEALTH SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376589309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHASE BREXTON HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	1111 NORTH CHARLES STREET
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21201
Country	:	US
Telephone Number	:	410-837-2050
Fax Number	:	410-752-1374

Provider Business Practice Location Address
First Line	:	5500 KNOLL NORTH DR
Second Line	:	STE 370
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2209
Country	:	US
Telephone Number	:	410-884-7831
Fax Number	:	410-715-3734

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	MR. KYLE EASTON
Credential	:
Telephone Number	:	410-837-2050

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/15/2024

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