Healthcare Provider Details

I. General information

NPI: 1275477986
Provider Name (Legal Business Name): INNEREDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S MORLEY ST
BALTIMORE MD
21229-3645
US

IV. Provider business mailing address

77 S MORLEY ST
BALTIMORE MD
21229-3645
US

V. Phone/Fax

Practice location:
  • Phone: 667-256-3190
  • Fax:
Mailing address:
  • Phone: 667-256-3190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARQUITA D THOMAS
Title or Position: OWNER
Credential:
Phone: 667-256-3190