Healthcare Provider Details

I. General information

NPI: 1871060293
Provider Name (Legal Business Name): ASSOCIATED SUBSTANCE ABUSE TREATMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 PARK AVE
BALTIMORE MD
21201-3514
US

IV. Provider business mailing address

232 PARK AVE
BALTIMORE MD
21201-3514
US

V. Phone/Fax

Practice location:
  • Phone: 443-386-7540
  • Fax:
Mailing address:
  • Phone: 443-386-7540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. LEWIS EVANS
Title or Position: CEO
Credential:
Phone: 443-386-7540