Healthcare Provider Details

I. General information

NPI: 1053899260
Provider Name (Legal Business Name): ROYAL MINDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 E BALTIMORE ST
BALTIMORE MD
21224-1509
US

IV. Provider business mailing address

3719 E BALTIMORE ST
BALTIMORE MD
21224-1509
US

V. Phone/Fax

Practice location:
  • Phone: 410-943-2424
  • Fax: 410-943-2323
Mailing address:
  • Phone: 410-943-2424
  • Fax: 410-943-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: AL MUFTAU A ADEITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 240-486-1238