Provider Demographics
NPI:1477310464
Name:HARFORD DIRECT CARE LLC
Entity Type:Organization
Organization Name:HARFORD DIRECT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRONES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, MSN-FNP
Authorized Official - Phone:443-707-2782
Mailing Address - Street 1:1309 COFFEEN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5777
Mailing Address - Country:US
Mailing Address - Phone:443-707-2782
Mailing Address - Fax:
Practice Address - Street 1:5000 THAYER CTR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1139
Practice Address - Country:US
Practice Address - Phone:443-707-2782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARFORD DIRECT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty