Healthcare Provider Details

I. General information

NPI: 1750386082
Provider Name (Legal Business Name): MGH COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17735 GEORGIA AVE STE 010
OLNEY MD
20832-2276
US

IV. Provider business mailing address

4061 POWDER MILL RD SUITE 500
CALVERTON MD
20705-3149
US

V. Phone/Fax

Practice location:
  • Phone: 301-570-7400
  • Fax: 301-570-7420
Mailing address:
  • Phone: 301-931-3100
  • Fax: 301-931-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR1084
License Number StateMD

VIII. Authorized Official

Name: MS. TRACI ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 301-931-3100