| NPI | 1407564602 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVERNE JOHNSON CEO 410-402-3311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-29 |