Provider Demographics
NPI:1962806091
Name:POTOMAC CASE MANAGEMENT SERVICES
Entity type:Organization
Organization Name:POTOMAC CASE MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-791-3087
Mailing Address - Street 1:324 E ANTIETAM ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5754
Mailing Address - Country:US
Mailing Address - Phone:301-791-3087
Mailing Address - Fax:
Practice Address - Street 1:417 E BALTIMORE ST STE B
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2339
Practice Address - Country:US
Practice Address - Phone:301-791-3087
Practice Address - Fax:301-393-0730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC CASE MANAGEMENT SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-17
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD880111800Medicaid