Deptment Of Juvenile Services
Community/Behavioral Health in Flintstone, MD. Organization (NPI-2).
NPI number1750502829
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1750502829
- Entity type
- Organization (NPI-2)
- Legal business name
- Deptment Of Juvenile Services
- Organization subpart
- No
- Enumeration date
- May 2, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Other names
- Green Ridge Youth Center (Doing Business As)
Practice location
10700 15 Mile Crk RoadFlintstone, MD 21530-3038
Phone 301-478-3069 · Fax 301-478-3009
Mailing address
10700 15 Mile Crk RoadFlintstone, MD 21530-3038
Phone 301-478-3069 · Fax 301-478-3009
Authorized official
Tammy Lynn Fisher
Administrator-Clinical Supervisor
3014783069
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