Healthcare Provider Details

I. General information

NPI: 1588818595
Provider Name (Legal Business Name): THOMAS ASSOCIATES FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N HAMMONDS FERRY RD SUITE A
LINTHICUM MD
21090-1355
US

IV. Provider business mailing address

825 N HAMMONDS FERRY RD SUITE A
LINTHICUM MD
21090-1355
US

V. Phone/Fax

Practice location:
  • Phone: 410-789-2635
  • Fax: 410-789-2767
Mailing address:
  • Phone: 410-789-2635
  • Fax: 410-789-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number4049
License Number StateMD

VIII. Authorized Official

Name: MR. EDWIN RICHARD BUTLER III
Title or Position: EXECUTIVE V.P.
Credential:
Phone: 443-661-1301