Organization
POTOMAC RIDGE- EASTERN SHORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANE P GORDON MA, ATR (THERAPIST)
(410) 221-0288
Entity
Organization
Contact information
Practice address
821 FIELDCREST RD, CAMBRIDGE, MD 21613-9423
(410) 221-0288
(410) 221-9588
Mailing address
821 FIELDCREST RD, CAMBRIDGE, MD 21613-9423
(410) 221-0288
(410) 221-9588
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
5337
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410520600
—
MD
05
—
410978300
—
MD
Enumeration date
03/08/2007
Last updated
08/14/2008
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