Healthcare Provider Details

I. General information

NPI: 1750952958
Provider Name (Legal Business Name): RCC COMMUNITY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GREENWOOD PL STE 100
PIKESVILLE MD
21208-2701
US

IV. Provider business mailing address

3 GREENWOOD PL STE 100
PIKESVILLE MD
21208-2701
US

V. Phone/Fax

Practice location:
  • Phone: 443-854-0638
  • Fax:
Mailing address:
  • Phone: 443-854-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TRACY RENNA THOMAS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 104-663-4036