Healthcare Provider Details

I. General information

NPI: 1730861170
Provider Name (Legal Business Name): 2ND JOURNEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 REISTERSTOWN RD 1ST FLOOR
BALTIMORE MD
21215-5018
US

IV. Provider business mailing address

5247 REISTERSTOWN RD FL 1
BALTIMORE MD
21215-5018
US

V. Phone/Fax

Practice location:
  • Phone: 240-475-2325
  • Fax:
Mailing address:
  • Phone: 240-475-2325
  • 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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRI FIELDS
Title or Position: CREDENTIALING CONSULTANT
Credential:
Phone: 443-567-6120