1790148807 NPI number — THREE LOWER COUNTIES COMMUNITY SERVICES, INC.

Table of content: (NPI 1790148807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790148807 NPI number — THREE LOWER COUNTIES COMMUNITY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790148807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALISBURY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21802-1978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1015
Provider Business Mailing Address Fax Number:
410-749-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30577 CAMP ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-749-1015
Provider Business Practice Location Address Fax Number:
410-749-1020
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLAND
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
410-749-1015

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 119591300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com