Potomac Ridge Behaviorial Health System Eastern Shore

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

10586 Issued in MD

Legal business name

POTOMAC RIDGE BEHAVIORIAL HEALTH SYSTEM EASTERN SHORE

Practice address

821 Fieldcrest Rd
Cambridge, MD 21613-9423

Phone

(410) 221-0288

Fax

(410) 228-9588

NPI assigned

Feb 16, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Aarti Kishen Schnatterly, LCSW-C

Title

Clinical Director

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": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1700920527",
    "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": "410-228-9588"
        },
        {
            "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": "410-228-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC RIDGE BEHAVIORIAL HEALTH SYSTEM EASTERN SHORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-16",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "SCHNATTERLY",
        "authorized_official_first_name": "AARTI",
        "authorized_official_middle_name": "KISHEN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "410-221-0288",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "MD",
            "license": "10586",
            "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": []
}

• Anna M Pokrywka, LCSW-C
• Potomac Ridge Behavioal Health Es
• Potomac Ridge Behavioral Health Es
• Potomac Ridge Behaviorial Health Eastern Shore
• Potomac Ridge Behaviorial Health Eastern Shore
• Potomac Ridge Behavorial Health Eastern Shore
• Potomac Ridge- Eastern Shore
• Jack L. Powell, LCSW-C
• Lori Ruth Powley, LCSW-C
• Adebowale Prest, MD

• All providers in Cambridge, MD
• 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 Jun 23, 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.