Provider Demographics
NPI:1992049100
Name:CORSICA RIVER MENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:CORSICA RIVER MENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PLASKON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-758-3050
Mailing Address - Street 1:120 BANJO LN
Mailing Address - Street 2:P.O. BOX 718
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-1002
Mailing Address - Country:US
Mailing Address - Phone:410-758-2211
Mailing Address - Fax:410-758-1223
Practice Address - Street 1:502 POPLAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1834
Practice Address - Country:US
Practice Address - Phone:443-225-5780
Practice Address - Fax:443-225-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4214099 00Medicaid