| NPI | 1043952880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORY TATAW CEO 410-205-2458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2022-09-16 |