Healthcare Provider Details

I. General information

NPI: 1346796885
Provider Name (Legal Business Name): COMMUNITY FIRST HEALTH CARE SERVICES COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N LINWOOD AVE
BALTIMORE MD
21205-2707
US

IV. Provider business mailing address

610 N LINWOOD AVE
BALTIMORE MD
21205-2707
US

V. Phone/Fax

Practice location:
  • Phone: 410-617-0127
  • Fax:
Mailing address:
  • Phone: 410-617-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMH-2077
License Number StateMD

VIII. Authorized Official

Name: KEVIN EUGENE HARVELL
Title or Position: PRESIDENT
Credential:
Phone: 410-361-1509