Healthcare Provider Details

I. General information

NPI: 1447231576
Provider Name (Legal Business Name): BALTIMORE COMMUNITY RESOURCE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 25TH ST
BALTIMORE MD
21218-5003
US

IV. Provider business mailing address

21 W 25TH ST
BALTIMORE MD
21218-5003
US

V. Phone/Fax

Practice location:
  • Phone: 410-366-1717
  • Fax: 410-889-4167
Mailing address:
  • Phone: 410-366-1717
  • Fax: 410-889-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number13138
License Number StateMD

VIII. Authorized Official

Name: MRS. ROBIN WOODELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-366-1717