Provider Demographics
NPI:1598592081
Name:CHESAPEAKE DEVELOPMENTAL SUPPORT SERVICES
Entity type:Organization
Organization Name:CHESAPEAKE DEVELOPMENTAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-838-6184
Mailing Address - Street 1:4214 SUMMER SHADE WAY
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4872
Mailing Address - Country:US
Mailing Address - Phone:443-838-6184
Mailing Address - Fax:
Practice Address - Street 1:11400 CRONRIDGE DR STE H
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2227
Practice Address - Country:US
Practice Address - Phone:443-838-6184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health