| NPI | 1477098044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMIEL CHICHEPORTICHE Program Sponsor 410-484-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MD 906136) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD 906136) |
| 261QM2800X Clinic/Center, Methadone Clinic (Licence: MD 906136) | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MD 906136) | |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2017-01-05 |