Provider Demographics
NPI:1508144619
Name:COMMUNITY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:TREPETIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-530-7583
Mailing Address - Street 1:1700 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1416
Mailing Address - Country:US
Mailing Address - Phone:410-484-1888
Mailing Address - Fax:410-484-3999
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 214
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-484-1888
Practice Address - Fax:410-484-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health