| NPI | 1770058943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MACE SHADID CEO/Director Of Finance & Logistics 410-324-7624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0401X Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2018-10-09 |