MEDICARE: NEXUS-WOODBOURNE FAMILY HEALING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033149257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS-WOODBOURNE FAMILY HEALING

Provider Business Mailing Address
First Line	:	1301 WOODBOURNE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-3316
Country	:	US
Telephone Number	:	410-433-1000
Fax Number	:	410-435-2938

Provider Business Practice Location Address
First Line	:	1301 WOODBOURNE AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21239-3316
Country	:	US
Telephone Number	:	410-433-1000
Fax Number	:	410-435-2938

Authorized Official
Title or Position	:	CORPORATE CONTROLLER
Name	:	DR. KENNETH VARBLE
Credential	:
Telephone Number	:	763-551-8640

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	12/07/2022

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Directions to “NEXUS-WOODBOURNE FAMILY HEALING ” Practice Location

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