| Tidalhealth Peninsula Regional, Inc. | |
|
201 Hall Hwy Crisfield MD 21817-1237 | |
| (410) 968-1200 | |
| Not Available |
| Full Name | Tidalhealth Peninsula Regional, Inc. |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 201 Hall Hwy, Crisfield, Maryland |
| Authorized Official Name and Position | Bruce Ishmael Ritchie (SR. VICE PRESIDENT/CFO) |
| Authorized Official Contact | 4105437298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidalhealth Peninsula Regional, Inc. Po Box 826880 Philadelphia PA 19182-6880 Ph: (410) 912-6989 | Tidalhealth Peninsula Regional, Inc. 201 Hall Hwy Crisfield MD 21817-1237 Ph: (410) 968-1200 |
| NPI Number | 1306507579 |
|---|---|
| Provider Enumeration Date | 01/10/2022 |
| Last Update Date | 01/10/2022 |
| Certification Date | 01/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306507579 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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