| NPI | 1508741778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG HOWARD LIPPENS Program Administrator 410-382-0528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2025-08-07 |
| Last Update Date | 2025-08-07 |