Healthcare Provider Details

I. General information

NPI: 1073282364
Provider Name (Legal Business Name): TREYWAY MULTI TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 W NORTH AVE
BALTIMORE MD
21217-1610
US

IV. Provider business mailing address

1839 W NORTH AVE
BALTIMORE MD
21217-1610
US

V. Phone/Fax

Practice location:
  • Phone: 443-992-0454
  • Fax:
Mailing address:
  • Phone: 443-992-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. VARNEY JAMES RICHARDSON III
Title or Position: CEO
Credential:
Phone: 443-992-0454