Potomac Ridge- Eastern Shore

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

5337 Issued in MD

Legal business name

POTOMAC RIDGE- EASTERN SHORE

Practice address

821 Fieldcrest Rd
Cambridge, MD 21613-9423

Phone

(410) 221-0288

Fax

(410) 221-9588

NPI assigned

Mar 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jane P Gordon, MA, ATR

Title

Therapist

Phone

(410) 221-0288

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1285765636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 FIELDCREST RD",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216139423",
            "telephone_number": "410-221-0288",
            "fax_number": "410-221-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 FIELDCREST RD",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216139423",
            "telephone_number": "410-221-0288",
            "fax_number": "410-221-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC RIDGE- EASTERN SHORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "410-221-0288",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA, ATR"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MD",
            "license": "5337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410520600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410978300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Potomac Ridge Behavioral Health Es
• Potomac Ridge Behaviorial Health Eastern Shore
• Potomac Ridge Behaviorial Health Eastern Shore
• Potomac Ridge Behaviorial Health System Eastern Shore
• Potomac Ridge Behavorial Health Eastern Shore
• Jack L. Powell, LCSW-C
• Lori Ruth Powley, LCSW-C
• Adebowale Prest, MD
• Lori Joy Price, LCPC
• Privia Medical Group, LLC

• Emotionally Disturbed Childrens' Residential Treatment Facility in Cambridge, MD
• Providers in Cambridge, MD by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.