NPIMap

Organization Active NPI

Maple Shade Youth and Family Services, Inc.

  • Community/Behavioral Health Agency
  • Princess Anne, MD
National Provider Identifier
1326376302
Registry record updated Apr 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.
Practice address
11760 Somerset Ave
Princess Anne, MD 21853-1239
Phone
(410) 621-5177
NPI assigned
Dec 2, 2009
Last updated
Apr 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2022

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

Authorized official

Name
Jessica Dawn Holloway-Hill
Title
Clinical Director
Phone
(410) 621-5177

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

11760 Somerset Ave
Princess Anne, MD 21853-1239

Mailing address

11760 Somerset Ave
Princess Anne, MD 21853-1239
Phone (410) 621-5177

Other names 1

  • Princess Anne Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Maple Shade Youth Family Services Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11760 Somerset Ave
Princess Anne, MD 21853
Phone (410) 621-5177

NPI Registry JSON

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

{
    "created_epoch": "1259712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649721600000",
    "number": "1326376302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11760 SOMERSET AVE",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531239",
            "telephone_number": "410-621-5177",
            "fax_number": "410-621-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11760 SOMERSET AVE",
            "city": "PRINCESS ANNE",
            "state": "MD",
            "postal_code": "218531239",
            "telephone_number": "410-621-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE SHADE YOUTH AND FAMILY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-02",
        "last_updated": "2022-04-12",
        "certification_date": "2022-04-12",
        "status": "A",
        "authorized_official_last_name": "HOLLOWAY-HILL",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "410-621-5177"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Princess Anne Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Princess Anne Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Princess Anne, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; 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.