Provider Demographics
NPI:1285109520
Name:C3 POWERED BY ABSOLUTECARE, LLC
Entity type:Organization
Organization Name:C3 POWERED BY ABSOLUTECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRENTLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-738-0281
Mailing Address - Street 1:2140 PEACHTREE RD NW STE 232
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1314
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:
Practice Address - Street 1:36 S PACA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1735
Practice Address - Country:US
Practice Address - Phone:410-328-3117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD887274100Medicaid