Healthcare Provider Details

I. General information

NPI: 1982749701
Provider Name (Legal Business Name): POTOMAC CASE MANAGEMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E ANTIETAM ST SUITE 301
HAGERSTOWN MD
21740-5754
US

IV. Provider business mailing address

324 E ANTIETAM ST SUITE 301
HAGERSTOWN MD
21740-5754
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-3087
  • Fax: 301-393-0730
Mailing address:
  • Phone: 301-791-3087
  • Fax: 301-393-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. DAWN R. JOHNS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-791-3087