LOWER SHORE CLINIC, INC. (NPI# 1770716458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770716458 |
| Entity Type | Organization |
| Organization Name | LOWER SHORE CLINIC, INC. |
| Other Organization Name | CORSICA RIVER MENTAL HEALTH SERVICES |
| Practice Address |
120 Banjo Ln Centreville MD 21617-1002 |
| Mailing Address |
716 N Division St Salisbury MD 21801-4156 |
| Practice Telephone | 4103413420 |
| Practice Fax Number | 4103413397 |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2009-09-03 |
| Authorized Official Name | TUESDAY TROTT (ADMINISTRATOR) |
| Authorized Official Telephone | 4103413420 |
| Is Organization Subpart | Y |
| Parent Organization Name | LOWER SHORE CLINIC, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | 23646 | MD | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 298470901 | 05 |
| Other Name | Type Code |
|---|---|
| Corsica River Mental Health Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417424466 | Lower Shore Clinic, Inc. | Community/Behavioral Health | 828 Airpax Rd # 600b, Cambridge, MD 21613-6401 | 2018-10-29 |
| 1275858417 | Lower Shore Clinic, Inc. | Community/Behavioral Health | 431 E Main St, Salisbury, MD 21804 | 2010-03-31 |
| 1154320646 | Lower Shore Clinic, Inc. | Clinic/Center | 505 E Main St, Salisbury, MD 21804 | 2005-07-18 |
| Street Address |
120 BANJO LN |
| City | CENTREVILLE |
| State | MD |
| Zip Code | 21617-1002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205822053 | Lesley Todd | Nurse Practitioner | 120 Banjo Ln, Centreville, MD 21617-1002 | 2005-09-26 |
| 1245877182 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2019-12-10 |
| 1346883360 | Courtney Marie Miller | Social Worker | 120 Banjo Ln, Centreville, MD 21617-1002 | 2019-10-22 |
| 1154983138 | Corsica River Mental Health Services, Inc | Case Management | 120 Banjo Ln, Centreville, MD 21617-1002 | 2019-07-01 |
| 1033695028 | Ashley Hall | Counselor | 120 Banjo Ln, Centreville, MD 21617-1002 | 2018-07-13 |
| 1295269785 | Corsica River Mental Health Services, Inc. | Clinic/Center | 120 Banjo Ln, Centreville, MD 21617-1002 | 2017-04-12 |
| 1568912657 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-10-12 |
| 1730636192 | Erin Elizabeth Cannon | Social Worker | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-09-02 |
| 1346608916 | Corsica River Mental Health Services, Inc | Clinic/Center | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-02-10 |
| 1437517000 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-02-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518322445 | Marianna Edmonston | Occupational Therapy Assistant | 205 Armstrong St., Genesis Rehabilitation Services Corsica Hills, Centreville, MD 21617 | 2015-12-18 |
| 1881089084 | Michelle Katherine Priddy | Specialist/Technologist | 125 Ruthsburg Rd., Centreville, MD 21617 | 2015-04-03 |
| 1801220579 | Kimberly Patrice Wilson | Counselor | 205 North Liberty St, Centreville, MD 21617 | 2013-08-29 |
| 1588940787 | Angela Renee Sommer | Speech-Language Pathologist | 205 Armstrong Street, Genesis Rehabilitation Services Corsica Hills, Centreville, MD 21617 | 2011-11-01 |
| 1497067144 | Alison Lynn Mccuen | Speech-Language Pathologist | 175 Ashland Drive, Centreville, MD 21617 | 2010-07-10 |
| 1427269406 | Hospice of Queen Anne's Inc. | Hospice Care, Community Based | 255 Comet Drive, Centreville, MD 21617 | 2007-05-24 |
| 1093921470 | Lillian Sheehan | Social Worker | 152 Courseval Drive, Ste 142, Centreville, MD 21617 | 2007-05-15 |
| 1184723942 | Centreville Drugs Inc | Durable Medical Equipment & Medical Supplies | 102 Commerce Street, Centreville, MD 21617 | 2006-09-21 |
| 1114022670 | James J Lucas | Dentist | 134 Coursevall Drive, Centerville, MD 21617 | 2006-09-13 |
| 1730129370 | Joseph C Titus | Social Worker | 120 Banjo Lane, Centreville, MD 21617 | 2006-06-08 |
| Find all providers in zip 21617 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033520275 | Humanitarian Homes of America | Community/Behavioral Health | 5650 Thorndyke Ct, Centreville, VA 20120-2866 | 2014-05-09 |
| 1700124831 | Community Behavioral Health, LLC | Community/Behavioral Health | 202 Coursevall Dr Ste 107, Centreville, MD 21617-1835 | 2013-01-24 |
| 1205193737 | Bridges Behavioral Health & Wellness | Community/Behavioral Health | 207 N Liberty St, Suite B, Centreville, MD 21617-1022 | 2012-04-23 |
| 1083983985 | The Learning Ladder, LLC | Community/Behavioral Health | 13608 Northbourne Dr, Centreville, VA 20120-1776 | 2011-12-21 |
| 1245877182 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2019-12-10 |
| 1174025944 | Project Chesapeake, LLC | Community/Behavioral Health | 202 Coursevall Dr Ste 104, Centreville, MD 21617-2805 | 2018-03-07 |
| 1427591767 | Diana O'brien, Lcsw. Med, LLC | Community/Behavioral Health | 5675 Stone Rd Ste 300, Centreville, VA 20120-1667 | 2016-11-18 |
| 1568912657 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-10-12 |
| 1396295697 | Community Behavioral Health LLC | Community/Behavioral Health | 142 Coursevall Dr, Centreville, MD 21617-1824 | 2016-10-11 |
| 1437517000 | Crossroads Community, Inc. | Community/Behavioral Health | 120 Banjo Ln, Centreville, MD 21617-1002 | 2016-02-10 |
| Find all providers in CENTREVILLE | ||||
| City | CENTREVILLE |
| Zip Code | 21617 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.