Healthcare Provider Details

I. General information

NPI: 1861932089
Provider Name (Legal Business Name): WEST CECIL HEALTH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4863 PULASKI HWY STE 200
PERRYVILLE MD
21903-1624
US

IV. Provider business mailing address

PO BOX 99
CONOWINGO MD
21918-0099
US

V. Phone/Fax

Practice location:
  • Phone: 410-378-9696
  • Fax: 410-378-0787
Mailing address:
  • Phone: 410-378-9696
  • Fax: 410-378-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JOHN RAGNAR NESS
Title or Position: INTERIM CEO/ CFO
Credential:
Phone: 443-731-2971