Healthcare Provider Details

I. General information

NPI: 1033724513
Provider Name (Legal Business Name): S AND S PROPERTIES 3
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6122 REISTERSTOWN RD
BALTIMORE MD
21215-3423
US

IV. Provider business mailing address

25 HOOKS LN STE 200
PIKESVILLE MD
21208-1619
US

V. Phone/Fax

Practice location:
  • Phone: 410-358-4415
  • Fax:
Mailing address:
  • Phone: 410-358-4415
  • Fax: 410-358-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SVYATOSLAV SHPARAGA
Title or Position: DIRECTOR
Credential:
Phone: 917-361-7545