Provider Demographics
NPI:1144872409
Name:ARUNDEL LODGE, INC
Entity type:Organization
Organization Name:ARUNDEL LODGE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARMOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-433-5900
Mailing Address - Street 1:2600 SOLOMONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1102
Mailing Address - Country:US
Mailing Address - Phone:443-433-5900
Mailing Address - Fax:410-841-6045
Practice Address - Street 1:92 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2432
Practice Address - Country:US
Practice Address - Phone:443-433-5900
Practice Address - Fax:410-841-6045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARUNDEL LODGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414478300Medicaid
MD409776900Medicaid