Healthcare Provider Details

I. General information

NPI: 1740227602
Provider Name (Legal Business Name): CHESAPEAKE YOUTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 FIELDCREST RD
CAMBRIDGE MD
21613-9423
US

IV. Provider business mailing address

821 FIELDCREST RD
CAMBRIDGE MD
21613-9423
US

V. Phone/Fax

Practice location:
  • Phone: 410-221-0288
  • Fax: 410-228-9588
Mailing address:
  • Phone: 410-221-0288
  • Fax: 410-228-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number09011
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number09011
License Number StateMD

VIII. Authorized Official

Name: MARY BLACKWELL
Title or Position: PATIENT ACCOUTS DIRECTOR
Credential:
Phone: 410-221-0288