| NPI | 1194205450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Senior Billing Clerk 410-467-5291 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MD BH000896) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: MD BH000897) |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: MD 904734) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-11-01 |