NPIMap

Organization Active NPI

Three Lower Counties Community Services, Inc.

Doing business as Chesapeake Health Care

  • Federally Qualified Health Center (FQHC)
  • Berlin, MD
National Provider Identifier
1376248393
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THREE LOWER COUNTIES COMMUNITY SERVICES, INC.
Doing business as
Chesapeake Health Care
Practice address
9714 Healthway Dr
Berlin, MD 21811-1154
Phone
(410) 641-3340
Fax
(410) 641-3341
NPI assigned
Mar 31, 2023
Last updated
Mar 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brian E Holland
Title
President & Ceo
Phone
(410) 749-1015

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

9714 Healthway Dr
Berlin, MD 21811-1154

Mailing address

PO Box 1978
Salisbury, MD 21802-1978
Phone (410) 749-1015

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Other names 1

  • Chesapeake Health Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230620001143 MD Part A Provider - Federally Qualified Health Center (FQHC) 3678484300 Practice locations: Berlin, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376248393. Details of each certification follow.

Federally qualified health center certification: CCN 211025

Legal name
THREE LOWER COUNTIES COMMUNITY SERVICES INC
Doing business as
CHESAPEAKE HEALTH CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2023
Last certification
Jun 7, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1994 in MD
Enrollment address
9714 Healthway Dr
Berlin, MD 21811-1154

Other NPIs with the same Medicare PAC ID 23

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Abdul K Garuba37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

Organizations that report the same tax identification number in the National Provider Directory.

View all 36

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kathleen Crossan Individual Corporate OfficerBoard Member Mar 30, 2011
Paula D. Brown Individual Corporate OfficerBoard Member Mar 31, 2015
D'Arcy Nicole Green Individual Corporate OfficerVice Chairperson May 27, 2009
Three Lower Counties Community Services Inc Organization, Salisbury, MD Corporation, Non-profit Operational/Managerial Control Feb 28, 1994
Ernest Satchell Individual Corporate OfficerBoard Member Feb 28, 2023
Everett L. McCabe Individual Corporate OfficerTreasurer Sep 27, 2016
Lilly Welch Individual Corporate OfficerBoard Member Feb 28, 2023
Lauren Taylor Individual Corporate OfficerSecretary Feb 27, 2008
Chris Labarge Individual Corporate OfficerChairperson Dec 16, 2009
Ernest D. Camarena Individual Corporate OfficerBoard Member Jan 28, 2014
Cecilia Campbell Individual Corporate OfficerBoard Member Oct 29, 2019
Brian E Holland Individual Corporate OfficerPresident & Ceo Jun 1, 2018
W-2 Managing Employee Jun 1, 2018
Operational/Managerial Control Jun 1, 2018

Owners & managing parties with NPI records 23

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 23

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Chesapeake Health CarePrincess Anne, MD, CCN 211935 Federally qualified health center Operational/Managerial Control Jun 1, 2018
Chesapeake Health CareBerlin, MD, CCN 211937 Federally qualified health center Operational/Managerial Control Feb 28, 1994
Chesapeake Health CareSalisbury, MD, CCN 211941 Federally qualified health center Operational/Managerial Control Feb 28, 1994
Chesapeake Health CarePocomoke City, MD, CCN 211943 Federally qualified health center Operational/Managerial Control Feb 28, 1994
Chesapeake Health CareSalisbury, MD, CCN 211010 Federally qualified health center Operational/Managerial Control Feb 28, 1994

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1376248393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1978",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218021978",
            "telephone_number": "410-749-1015",
            "fax_number": "410-749-0654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9714 HEALTHWAY DR",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111154",
            "telephone_number": "410-641-3340",
            "fax_number": "410-641-3341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE LOWER COUNTIES COMMUNITY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "410-749-1015",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chesapeake Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berlin, MD

Sources for this page

Verify at the official NPI Registry.