Provider Demographics
NPI:1285247817
Name:BLACK ROCK INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:BLACK ROCK INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-790-4938
Mailing Address - Street 1:17666 TECHNOLOGY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-2074
Mailing Address - Country:US
Mailing Address - Phone:301-790-4938
Mailing Address - Fax:301-850-2135
Practice Address - Street 1:120 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4810
Practice Address - Country:US
Practice Address - Phone:301-790-4938
Practice Address - Fax:301-850-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)