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General NPI Number Information
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NPI Number | 1588785471
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Entity Type | Organization
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Legal Business Name | WESTERN MARYLAND HEALTH SYSTEM BRADDOCK HOSPITAL CORPORATION
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 300 E OLDTOWN RD
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City | CUMBERLAND
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State | MD
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Zip | 21502-3600
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Country | US
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Telephone | 301-722-0199
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Fax | 301-759-3623
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Provider Business Mailing Address
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Address Line | 300 E OLDTOWN RD
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City | CUMBERLAND
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State | MD
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Zip | 21502-3600
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Country | US
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Telephone | 301-722-0199
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Fax | 301-759-3623
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Authorized Official
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Title or Position | SR VP CFO
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Name | KIMBERLY S REPAC
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Credential |
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Telephone | 301-723-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | MD
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