| NPI | 1679863344 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ROTH Executive Director 410-837-2258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center Dental (Licence: MD 9848) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder (Licence: MD 904244) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-08-16 |