Provider Demographics
NPI:1982146353
Name:ACCESS CARROLL, LLC
Entity Type:Organization
Organization Name:ACCESS CARROLL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-871-3218
Mailing Address - Street 1:10 DISTILLERY DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-871-1478
Mailing Address - Fax:443-952-7588
Practice Address - Street 1:10 DISTILLERY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-871-1478
Practice Address - Fax:443-952-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4226216 00Medicaid
MD1891113221OtherEMPLOYER NPI