| NPI | 1487005120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY KENDRICK Executive Director 410-576-9626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MD VA2142) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 347C00000X Private Vehicle | |
| 385H00000X Respite Care | |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2016-06-23 |