Healthcare Provider Details

I. General information

NPI: 1255045407
Provider Name (Legal Business Name): ACHIEVE BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3967 HICKORY AVE
BALTIMORE MD
21211-1822
US

IV. Provider business mailing address

2012 S TOLLGATE RD STE 200
BEL AIR MD
21015-5902
US

V. Phone/Fax

Practice location:
  • Phone: 410-599-2031
  • Fax:
Mailing address:
  • Phone: 410-599-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM POGGI
Title or Position: CEO
Credential:
Phone: 410-599-2031