Provider Demographics
NPI:1487942611
Name:SLADE HEALTHCARE, INC.
Entity type:Organization
Organization Name:SLADE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EYVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-581-7413
Mailing Address - Street 1:304 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5312
Mailing Address - Country:US
Mailing Address - Phone:410-581-7413
Mailing Address - Fax:410-581-7415
Practice Address - Street 1:304 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5312
Practice Address - Country:US
Practice Address - Phone:410-581-7413
Practice Address - Fax:410-581-7415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty