Provider Demographics
NPI:1528275500
Name:PROLOGUE, INC
Entity type:Organization
Organization Name:PROLOGUE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SENDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-653-6190
Mailing Address - Street 1:3 MILFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6019
Mailing Address - Country:US
Mailing Address - Phone:410-653-6190
Mailing Address - Fax:410-653-6566
Practice Address - Street 1:3 MILFORD MILL RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6019
Practice Address - Country:US
Practice Address - Phone:410-653-6190
Practice Address - Fax:410-653-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2376251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589211200Medicaid