Healthcare Provider Details

I. General information

NPI: 1336363944
Provider Name (Legal Business Name): WASHINGTON COUNTY HUMAN DEVELOPMENT COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 N EAST ST
FREDERICK MD
21701-4622
US

IV. Provider business mailing address

916 N EAST ST
FREDERICK MD
21701-4622
US

V. Phone/Fax

Practice location:
  • Phone: 301-293-6055
  • Fax: 301-293-6089
Mailing address:
  • Phone: 301-293-6055
  • Fax: 301-293-6089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number13286
License Number StateMD

VIII. Authorized Official

Name: MR. DEREK DAVID SMITH
Title or Position: DIRECTOR OF DAY PROGRAM SERVICES
Credential:
Phone: 301-791-5421