Healthcare Provider Details

I. General information

NPI: 1053856047
Provider Name (Legal Business Name): T&F ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2016
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 W LOMBARD ST
BALTIMORE MD
21201-1057
US

IV. Provider business mailing address

880 W LOMBARD ST
BALTIMORE MD
21201-1057
US

V. Phone/Fax

Practice location:
  • Phone: 361-350-6621
  • Fax:
Mailing address:
  • Phone: 361-350-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number261QR0405X
License Number StateMD

VIII. Authorized Official

Name: EDDIE FREEMAN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 361-350-6621