Healthcare Provider Details

I. General information

NPI: 1104404110
Provider Name (Legal Business Name): CHESAPEAKE CARE RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MARYSVILLE RD
NORTH EAST MD
21901-2317
US

IV. Provider business mailing address

80 MARYSVILLE RD
NORTH EAST MD
21901-2317
US

V. Phone/Fax

Practice location:
  • Phone: 410-287-5040
  • Fax:
Mailing address:
  • Phone: 410-287-5040
  • Fax: 410-287-9511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JANET KELLY
Title or Position: PRESIDENT
Credential:
Phone: 410-287-5040