| Organization Name: | TRI-STATE COMMUNITY HEALTH CENTER, INC |
| NPI Number: | 1083055081 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHEILA J DESHONG (COO) |
| Mailing Address: | 261 Berkmore Pl Suite 1a Berkeley Springs |
| State: | WV US |
| Postal Code: | 254116247 |
| Phone Number: | 3042585790 |
| Fax Number: | 3042583745 |
| NPI Enumeration Date: | 07/08/2013 |
| NPI Last Update Date: | 02/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 2291-3644 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |