Healthcare Provider Details

I. General information

NPI: 1306539226
Provider Name (Legal Business Name): CHOICE RECOVERY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 REISTERSTOWN RD STE 307
BALTIMORE MD
21215-2686
US

IV. Provider business mailing address

6615 REISTERSTOWN RD STE 307
BALTIMORE MD
21215-2686
US

V. Phone/Fax

Practice location:
  • Phone: 410-505-8605
  • Fax: 240-770-0436
Mailing address:
  • Phone: 410-505-8605
  • Fax: 240-770-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TRISTAN JULIAN SHOCKLEY
Title or Position: CEO
Credential:
Phone: 240-786-1001