1821440009 NPI number — MULTIDIMENSIONAL COMMUNITY HEALTH SERVICES INC

Table of content: (NPI 1821440009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821440009 NPI number — MULTIDIMENSIONAL COMMUNITY HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MULTIDIMENSIONAL COMMUNITY HEALTH 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:
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:
1821440009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7841 AMERICANA CIR
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21060-7803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-449-9991
Provider Business Mailing Address Fax Number:
410-768-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
515 E JOPPA RD
Provider Second Line Business Practice Location Address:
100/104
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-337-0938
Provider Business Practice Location Address Fax Number:
410-337-2104
Provider Enumeration Date:
07/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ABRAHAM LEWIS
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
443-449-9991

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  LPG7130 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 302R00000X , with the licence number: LGP7130 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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