Provider Demographics
NPI:1396395265
Name:TSG COMMUNITY SERVICES
Entity Type:Organization
Organization Name:TSG COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADEGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-475-8074
Mailing Address - Street 1:12 SHARON CT APT 304
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4543
Mailing Address - Country:US
Mailing Address - Phone:240-475-8074
Mailing Address - Fax:301-604-6178
Practice Address - Street 1:12 SHARON CT APT 304
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4543
Practice Address - Country:US
Practice Address - Phone:240-475-8074
Practice Address - Fax:301-604-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization