Healthcare Provider Details

I. General information

NPI: 1003968991
Provider Name (Legal Business Name): ALLEGANY COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501-12503 WILLOWBROOK RD
CUMBERLAND MD
21502
US

IV. Provider business mailing address

PO BOX 1745
CUMBERLAND MD
21501-1745
US

V. Phone/Fax

Practice location:
  • Phone: 301-759-5050
  • Fax: 301-777-2098
Mailing address:
  • Phone: 301-759-5000
  • Fax: 301-777-5674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number903068
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number903070
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number903069
License Number StateMD

VIII. Authorized Official

Name: DR. SUE RAVER
Title or Position: HEALTH OFFICER
Credential: MD, MPH
Phone: 301-759-5001