Healthcare Provider Details

I. General information

NPI: 1104133925
Provider Name (Legal Business Name): BALTIMORE BEHAVIORAL HEALTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ARLINGTON AVE
BALTIMORE MD
21223-2671
US

IV. Provider business mailing address

1101 WEST PRATT STREET
BALTIMORE MD
21223-2671
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax: 410-962-7194
Mailing address:
  • Phone: 410-962-7180
  • Fax: 410-962-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WILLIAMS HATHAWAY
Title or Position: CEO
Credential:
Phone: 410-962-7180