| NPI | 1942281423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORENE LAKE Executive Director 410-974-6829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: MD 14717) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2020-08-22 |