MEDICARE: ROYAL MINDS INC.

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1386117737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL MINDS INC.

Provider Business Mailing Address
First Line	:	3719 E BALTIMORE ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-1509
Country	:	US
Telephone Number	:	240-486-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	4042 HILLEN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-2203
Country	:	US
Telephone Number	:	410-943-2424
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	AL MUFTAU A ADEITE
Credential	:
Telephone Number	:	240-486-1238

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	02/05/2020

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