Healthcare Provider Details

I. General information

NPI: 1164402467
Provider Name (Legal Business Name): GUY L. ELDRIDGE CSC-AD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH CARE FOR THE HOMELESS 111 PARK AVE
BALTIMORE MD
21201
US

IV. Provider business mailing address

HEALTH CARE FOR THE HOMELESS 111 PARK AVE
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-4292
  • Fax: 410-837-8020
Mailing address:
  • Phone: 410-837-5533
  • Fax: 410-837-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC1224
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: