1851480065 NPI number — THREE SPRINGS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851480065 NPI number — THREE SPRINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE SPRINGS, 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:
1851480065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21555-0008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-478-5721
Provider Business Mailing Address Fax Number:
301-478-5723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20700 WAGONER CUTOFF ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-478-5721
Provider Business Practice Location Address Fax Number:
301-478-5723
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALCH
Authorized Official First Name:
BROOKE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-880-3339

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  DJS LICENSE NO # , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05-PD-042 . This is a "STATE DJS CONTRACT" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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