Healthcare Provider Details

I. General information

NPI: 1972361681
Provider Name (Legal Business Name): RESTORATIVE TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N COLLINGTON AVE
BALTIMORE MD
21213-3313
US

IV. Provider business mailing address

1408 N BERWICK CT
BEL AIR MD
21015-5626
US

V. Phone/Fax

Practice location:
  • Phone: 443-226-3906
  • Fax:
Mailing address:
  • Phone: 443-226-3906
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. COREA CHARLISE MITTER BUGG
Title or Position: DIRECTOR
Credential:
Phone: 443-226-3906