| NPI | 1215116470 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD S JOHNSON Clinic Director 410-200-5210 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: MD 347205) |
| Additional Taxonomies | 261QM2800X Clinic/Center Methadone (Licence: MD 347205) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2008-07-23 |