Healthcare Provider Details

I. General information

NPI: 1285938258
Provider Name (Legal Business Name): THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32033 BEAVER RUN DR
SALISBURY MD
21804-1773
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1015
  • Fax:
Mailing address:
  • Phone: 410-749-1015
  • Fax:

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: JOAN ROBBINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-749-1015