Healthcare Provider Details

I. General information

NPI: 1184134538
Provider Name (Legal Business Name): WE DID DAT RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 01/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GEORGE ST
BALTIMORE MD
21201-1353
US

IV. Provider business mailing address

7231 HARFORD RD
BALTIMORE MD
21234-7701
US

V. Phone/Fax

Practice location:
  • Phone: 410-419-7792
  • Fax:
Mailing address:
  • Phone: 410-444-0300
  • Fax: 410-444-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUSTLYN WARD
Title or Position: ADDICTION COUNSELOR
Credential: MHS, CDC
Phone: 410-419-7792