MEDICARE: E.R.I.C.'S: A PLACE FOR ANGELS

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	251S00000X	Community/Behavioral Health Agency		MD

General Provider Information

NPI Number	:	1477983146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E.R.I.C.'S: A PLACE FOR ANGELS

Provider Business Mailing Address
First Line	:	6901 CHIPPEWA DR
Second Line	:
City	:	MT WASHINGTON
State	:	MD
Zip	:	21209-1436
Country	:	US
Telephone Number	:	410-602-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	6901 CHIPPEWA DR
Second Line	:
City	:	MT WASHINGTON
State	:	MD
Zip	:	21209-1436
Country	:	US
Telephone Number	:	410-602-5191
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. ERICA GAIL WALLACE
Credential	:
Telephone Number	:	410-602-5191

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	11/18/2013

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