Healthcare Provider Details

I. General information

NPI: 1083084180
Provider Name (Legal Business Name): INSTITUTE FOR FAMILY CENTERED SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 LORD BALTIMORE DR STE H
BALTIMORE MD
21244-2671
US

IV. Provider business mailing address

313 CONGRESS ST 5TH FLOOR
BOSTON MA
02210-1218
US

V. Phone/Fax

Practice location:
  • Phone: 410-455-4600
  • Fax:
Mailing address:
  • Phone: 617-790-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARY PATRICIA RODENBERG-ROBERTS
Title or Position: VICE PRESIDENT & SR. ASST GC
Credential:
Phone: 952-836-2234