Provider Demographics
NPI:1316050867
Name:FLAGSHIP NORTH
Entity type:Organization
Organization Name:FLAGSHIP NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:HMS
Authorized Official - Phone:301-707-6517
Mailing Address - Street 1:157 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2319
Mailing Address - Country:US
Mailing Address - Phone:301-722-3215
Mailing Address - Fax:301-722-1450
Practice Address - Street 1:157 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2319
Practice Address - Country:US
Practice Address - Phone:301-722-3215
Practice Address - Fax:301-772-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies