Healthcare Provider Details

I. General information

NPI: 1922120849
Provider Name (Legal Business Name): CHEAPEAKE BEHAVIORAL HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 NORTH ST # D
ELKTON MD
21921-5505
US

IV. Provider business mailing address

215 NORTH ST # D
ELKTON MD
21921-5505
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-4222
  • Fax: 410-398-8678
Mailing address:
  • Phone: 410-398-4222
  • Fax: 410-398-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number01670
License Number StateMD

VIII. Authorized Official

Name: DR. RICHARD H BAYER
Title or Position: CEO
Credential: PH.D.
Phone: 410-398-4222