Healthcare Provider Details

I. General information

NPI: 1982237293
Provider Name (Legal Business Name): PROJECT PLASE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 OLD FREDERICK RD
BALTIMORE MD
21229-3650
US

IV. Provider business mailing address

3601 OLD FREDERICK RD
BALTIMORE MD
21229-3650
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-1400
  • Fax:
Mailing address:
  • Phone: 410-837-1400
  • Fax: 410-837-6130

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 Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY SLICHER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-837-1400