Healthcare Provider Details

I. General information

NPI: 1013469832
Provider Name (Legal Business Name): SOUTHERN MARYLAND COMMUNITY NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 PRINCE FREDERICK BLVD
PRINCE FREDERICK MD
20678-3139
US

IV. Provider business mailing address

PO BOX 998
PRINCE FREDERICK MD
20678-0998
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4787
  • Fax: 410-535-4965
Mailing address:
  • Phone: 410-535-4787
  • Fax: 410-535-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KAREN E CARLONI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-535-4787