| NPI | 1275092611 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA HOLEVAS Billing And Credentialing Manager 443-418-9957 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2021-10-04 |