Provider Demographics
NPI:1699797704
Name:CHARLESTOWN COMMUNITY, INC
Entity type:Organization
Organization Name:CHARLESTOWN COMMUNITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-737-8838
Mailing Address - Street 1:715 MAIDEN CHOICE LN
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5999
Mailing Address - Country:US
Mailing Address - Phone:410-247-3400
Mailing Address - Fax:410-204-7237
Practice Address - Street 1:709 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3934
Practice Address - Country:US
Practice Address - Phone:410-247-3400
Practice Address - Fax:410-204-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD94341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAM12Medicare PIN