MEDICARE: TRICO CLINICAL SERVICES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2055X	Child Mental Illness Respite Care

General Provider Information

NPI Number	:	1649612524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICO CLINICAL SERVICES LTD

Provider Business Mailing Address
First Line	:	PO BOX 826
Second Line	:
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-0826
Country	:	US
Telephone Number	:	301-862-4961
Fax Number	:

Provider Business Practice Location Address
First Line	:	46940 S SHANGRI LA DR
Second Line	:	SUITE 10
City	:	LEXINGTON PARK
State	:	MD
Zip	:	20653-1037
Country	:	US
Telephone Number	:	301-862-4961
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	MS. HELGA C HERTLEIN
Credential	:
Telephone Number	:	301-862-4961

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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Directions to “TRICO CLINICAL SERVICES LTD ” Practice Location

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