Organization
TRI-STATE COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHEILA J DESHONG (COO)
(301) 678-5187
Entity
Organization
Contact information
Practice address
261 BERKMORE PL, SUITE 1A, BERKELEY SPRINGS, WV 25411-6247
(304) 258-5790
(304) 258-3745
Mailing address
109 RAYLOC DR, HANCOCK, MD 21750-1518
(301) 678-5187
(301) 678-5797
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
2291-3644
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511021
FQHC
—
Enumeration date
07/08/2013
Last updated
02/21/2014
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