Healthcare Provider Details

I. General information

NPI: 1376891945
Provider Name (Legal Business Name): DAYSPRING PROGRAMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 N PATTERSON PARK AVE
BALTIMORE MD
21213-3440
US

IV. Provider business mailing address

1125 N PATTERSON PARK AVE
BALTIMORE MD
21213-3440
US

V. Phone/Fax

Practice location:
  • Phone: 410-563-3459
  • Fax: 410-276-0036
Mailing address:
  • Phone: 410-563-3459
  • Fax: 410-276-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: PAM PALABIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-563-3459