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NPI Code Detail

MEDICARE: SOUTHERN MARYLAND COMMUNITY NETWORK, INC

MEDICARE: SOUTHERN MARYLAND COMMUNITY NETWORK, INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1548807423
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN MARYLAND COMMUNITY NETWORK, INC
Provider Business Mailing Address
First Line : PO BOX 998
Second Line :
City : PRINCE FREDERICK
State : MD
Zip : 20678-0998
Country : US
Telephone Number : 410-535-4787
Fax Number : 410-535-4965
Provider Business Practice Location Address
First Line : 2670 CRAIN HWY STE 505
Second Line :
City : WALDORF
State : MD
Zip : 20601-2819
Country : US
Telephone Number : 301-932-9146
Fax Number : 301-932-9361
Authorized Official
Title or Position : OPERATIONS DIRECTOR
Name : MICHAEL RADCLIFF
Credential :
Telephone Number : 410-535-4787
Provider Enumeration Date : 12/10/2019
Last Update Date : 12/10/2019

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Directions to “SOUTHERN MARYLAND COMMUNITY NETWORK, INC ” Practice Location

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