| NPI | 1336120021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR WIGGINS Executive Director 410-433-5255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 323P00000X Psychiatric Residential Treatment Facility (Licence: MD 12650) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: MD 11688) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2021-03-04 |