Provider Demographics
NPI:1427299049
Name:GLEN BURNIE HEALTH CENTER
Entity type:Organization
Organization Name:GLEN BURNIE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER, ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MS
Authorized Official - First Name:CECELIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-222-7135
Mailing Address - Street 1:3 HARRY S TRUMAN PKWY
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7031
Mailing Address - Country:US
Mailing Address - Phone:410-222-7135
Mailing Address - Fax:410-222-4173
Practice Address - Street 1:416 A ST SW
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3406
Practice Address - Country:US
Practice Address - Phone:410-222-7135
Practice Address - Fax:410-222-4173
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL COUNTY DEPARTMENT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD702191700Medicaid