Provider Demographics
NPI:1861932089
Name:WEST CECIL HEALTH CENTER INC.
Entity type:Organization
Organization Name:WEST CECIL HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CEO/ CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAGNAR
Authorized Official - Last Name:NESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-731-2971
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:CONOWINGO
Mailing Address - State:MD
Mailing Address - Zip Code:21918-0099
Mailing Address - Country:US
Mailing Address - Phone:410-378-9696
Mailing Address - Fax:410-378-0787
Practice Address - Street 1:4863 PULASKI HWY STE 200
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-1624
Practice Address - Country:US
Practice Address - Phone:410-378-9696
Practice Address - Fax:410-378-0787
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CECIL HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
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
MD414977700Medicaid
MD211868Medicare PIN