Healthcare Provider Details

I. General information

NPI: 1285505735
Provider Name (Legal Business Name): CLEAR WATER RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 PARK HEIGHTS AVE
BALTIMORE MD
21215-6331
US

IV. Provider business mailing address

7916 MANSION HOUSE XING
PASADENA MD
21122-6313
US

V. Phone/Fax

Practice location:
  • Phone: 443-571-9174
  • Fax: 410-364-8284
Mailing address:
  • Phone: 410-260-9338
  • Fax: 410-364-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER L BLACK
Title or Position: CEO
Credential:
Phone: 410-260-9338