NPIMap

Organization Active NPI

Safe Harbor Behavioral Care Chesapeake LLC

  • Clinical Social Worker
  • Annapolis, MD
National Provider Identifier
1295246718
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
SAFE HARBOR BEHAVIORAL CARE CHESAPEAKE LLC
Practice address
108 Old Solomons Island Rd Unit 5
Annapolis, MD 21401-3845
Phone
(410) 807-2626
NPI assigned
Oct 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Selena Eldride
Title
Regional Director
Phone
(410) 807-2626

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary

Addresses

Primary practice location

108 Old Solomons Island Rd Unit 5
Annapolis, MD 21401-3845

Mailing address

946 Nabbs Creek Rd
Glen Burnie, MD 21060-8434
Phone (410) 807-2626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171219003042 MD Part B Supplier - Clinic/Group Practice 0042578171 Receives reassigned benefits from 12 practitioners
Practice locations: Glen Burnie, MD; Annapolis, MD; Stevensville, MD; Severn, MD; Queenstown, MD; Pasadena, MD; Harwood, MD; Hanover, MD…

National Provider Directory

National Provider Directory

Locations

255 West St
Annapolis, MD 21401

884 Chesterfield Rd
Annapolis, MD 21401

108 Old Solomons Island Rd
Ste U5
Annapolis, MD 21401

108 Old Solomons Island Rd
Unit 5
Annapolis, MD 21401
Phone (410) 807-2626

16010 Annapolis Rd
Bowie, MD 20715
Phone (301) 809-0160

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1508803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1295246718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 NABBS CREEK RD",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210608434",
            "telephone_number": "410-807-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 OLD SOLOMONS ISLAND RD UNIT 5",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013845",
            "telephone_number": "410-807-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFE HARBOR BEHAVIORAL CARE CHESAPEAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-24",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ELDRIDE",
        "authorized_official_first_name": "SELENA",
        "authorized_official_title_or_position": "REGIONAL DIRECTOR",
        "authorized_official_telephone_number": "410-807-2626"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.