Provider Demographics
NPI:1962111724
Name:HEALTHPORT
Entity type:Organization
Organization Name:HEALTHPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OUTPATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-202-2651
Mailing Address - Street 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7033 WORCESTER HWY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:MD
Practice Address - Zip Code:21841-2149
Practice Address - Country:US
Practice Address - Phone:410-341-3420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHPORT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-21
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health