Provider Demographics
NPI:1316345051
Name:AA COUNTY DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:AA COUNTY DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY HEALTH OFFICER/OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAURESKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-222-7377
Mailing Address - Street 1:3 HARRY S TRUMAN PKWY
Mailing Address - Street 2:HD#19
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7031
Mailing Address - Country:US
Mailing Address - Phone:410-222-7135
Mailing Address - Fax:410-222-4173
Practice Address - Street 1:122 LANGLEY RD N
Practice Address - Street 2:STE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6531
Practice Address - Country:US
Practice Address - Phone:410-222-0100
Practice Address - Fax:410-222-0105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANNE ARUNDEL CO DEPT OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM2800X
MD904466261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone