| NPI | 1528790821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDER BLACK Owner 410-260-9338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2024-04-05 |