Healthcare Provider Details

I. General information

NPI: 1225564503
Provider Name (Legal Business Name): ANNE ARUNDEL COUNTY DEPT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 BESTGATE RD STE 300
ANNAPOLIS MD
21401-3472
US

IV. Provider business mailing address

839 BESTGATE RD STE 300
ANNAPOLIS MD
21401-3472
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6001
  • Fax: 410-222-7348
Mailing address:
  • Phone: 410-222-6001
  • Fax: 410-222-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. TIMOTHY LAURESKA
Title or Position: DEPUTY HEALTH OFFICER, OPERATIONS
Credential:
Phone: 410-222-7377