Healthcare Provider Details

I. General information

NPI: 1316797038
Provider Name (Legal Business Name): FIRST STOP TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 BEAUMONT AVE APT 16
BALTIMORE MD
21212-4383
US

IV. Provider business mailing address

499 BEAUMONT AVE APT 16
BALTIMORE MD
21212-4383
US

V. Phone/Fax

Practice location:
  • Phone: 410-340-5409
  • Fax:
Mailing address:
  • Phone: 410-340-5409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. CHARLOTTE RICHARDS
Title or Position: CEO
Credential: CAC-AD- S
Phone: 410-340-5409