Provider Demographics
NPI:1437697273
Name:WEST CECIL HEALTH CENTER INC.
Entity Type:Organization
Organization Name:WEST CECIL HEALTH CENTER INC.
Other - Org Name:BEACON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO/ CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAGNAR
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-378-9696
Mailing Address - Street 1:253 LEWIS LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3750
Mailing Address - Country:US
Mailing Address - Phone:443-502-7060
Mailing Address - Fax:410-378-9922
Practice Address - Street 1:253 LEWIS LN
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3750
Practice Address - Country:US
Practice Address - Phone:443-502-7060
Practice Address - Fax:410-378-9922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CECIL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414977700Medicaid