Healthcare Provider Details

I. General information

NPI: 1841829892
Provider Name (Legal Business Name): CMDS RESIDENTIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S FULTON AVE
BALTIMORE MD
21223-2306
US

IV. Provider business mailing address

5307 AERIE CT
CLARKSVILLE MD
21029-1103
US

V. Phone/Fax

Practice location:
  • Phone: 410-868-5638
  • Fax:
Mailing address:
  • Phone: 240-447-6870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KARL PFEFFER
Title or Position: OWNER
Credential:
Phone: 240-447-6870