Healthcare Provider Details

I. General information

NPI: 1639603012
Provider Name (Legal Business Name): CORSICA RIVER MENTAL HEALTH SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 N MAIN ST
FEDERALSBURG MD
21632-1081
US

IV. Provider business mailing address

120 BANJO LN
CENTREVILLE MD
21617-1002
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-0511
  • Fax: 410-754-6080
Mailing address:
  • Phone: 410-758-2211
  • Fax: 410-758-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELSEY HORNEY
Title or Position: HR DIRECTOR
Credential:
Phone: 410-758-3050