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General NPI Number Information
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NPI Number | 1508144619
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH CENTER, LLC
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Dates
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Enumeration Date | 07/25/2011
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 1700 REISTERSTOWN RD SUITE 214
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City | BALTIMORE
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State | MD
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Zip | 21208-1416
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Country | US
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Telephone | 410-484-1888
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Fax | 410-484-3999
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Provider Business Mailing Address
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Address Line | 1700 REISTERSTOWN RD SUITE 214
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City | BALTIMORE
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State | MD
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Zip | 21208-1416
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Country | US
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Telephone | 410-484-1888
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Fax | 410-484-3999
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Authorized Official
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Title or Position | MANAGER
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Name | MR. ALEXANDER TREPETIN
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Credential |
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Telephone | 410-530-7583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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