Healthcare Provider Details

I. General information

NPI: 1912459017
Provider Name (Legal Business Name): PROJECT CHESAPEAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 SHERRY LN
PRINCE FREDERICK MD
20678-3231
US

IV. Provider business mailing address

185 ADMIRAL COCHRANE DR STE 120
ANNAPOLIS MD
21401-7600
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5780
  • Fax:
Mailing address:
  • Phone: 443-440-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17401
License Number StateMD

VIII. Authorized Official

Name: JOSEPH ROGERS
Title or Position: PARTNER
Credential:
Phone: 443-440-5780