Healthcare Provider Details

I. General information

NPI: 1003366899
Provider Name (Legal Business Name): MCCREADY FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HALL HWY
CRISFIELD MD
21817-1237
US

IV. Provider business mailing address

201 HALL HWY
CRISFIELD MD
21817-1237
US

V. Phone/Fax

Practice location:
  • Phone: 410-968-1029
  • Fax: 410-968-1025
Mailing address:
  • Phone: 410-968-1029
  • Fax: 410-968-1025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANKLIN LEE COLLINS
Title or Position: REIMBURSEMENT SUPERVISOR
Credential:
Phone: 410-968-1029