1992889737 NPI number — THREE LOWER COUNTIES COMMUNITY SERVICES INC

Table of content: (NPI 1992889737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992889737 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:
1992889737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32033 BEAVER RUN DR
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:
21804-1773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-749-1015
Provider Business Mailing Address Fax Number:
410-651-2071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12137 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCESS ANNE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21853-1358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-651-5555
Provider Business Practice Location Address Fax Number:
410-651-2071
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P04533 , 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: 012057000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2038199 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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