Provider Demographics
NPI:1851480065
Name:THREE SPRINGS, INC.
Entity Type:Organization
Organization Name:THREE SPRINGS, INC.
Other - Org Name:NEW DOMINION MARYLAND RESIDENTIAL TREATMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BALCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-880-3339
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:OLDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21555-0008
Mailing Address - Country:US
Mailing Address - Phone:301-478-5721
Mailing Address - Fax:301-478-5723
Practice Address - Street 1:20700 WAGONER CUTOFF ROAD
Practice Address - Street 2:
Practice Address - City:OLDTOWN
Practice Address - State:MD
Practice Address - Zip Code:21555
Practice Address - Country:US
Practice Address - Phone:301-478-5721
Practice Address - Fax:301-478-5723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDJS LICENSE NO #322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05-PD-042OtherSTATE DJS CONTRACT