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General NPI Number Information
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NPI Number | 1780659136
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Entity Type | Organization
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Legal Business Name | BROOK LANE HEALTH SERVICES
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Dates
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Enumeration Date | 02/21/2006
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 13215 BROOK LANE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1514
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Country | US
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Telephone | 301-733-0330
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Fax | 301-733-4038
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Provider Business Mailing Address
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Address Line | 13215 BROOK LANE
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City | HAGERSTOWN
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State | MD
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Zip | 21742-1435
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Country | US
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Telephone | 301-733-0330
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Fax | 301-733-4038
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Authorized Official
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Title or Position | COORDINATOR/MANAGED CARE
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Name | MRS. KRISTY POFFENBERGER
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Credential |
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Telephone | 301-733-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 21-002
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License Number State | MD
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