Healthcare Provider Details

I. General information

NPI: 1669648390
Provider Name (Legal Business Name): WARWICK MANOR BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 WARWICK RD
EAST NEW MARKET MD
21631-1420
US

IV. Provider business mailing address

3680 WARWICK RD
EAST NEW MARKET MD
21631-1420
US

V. Phone/Fax

Practice location:
  • Phone: 800-344-6423
  • Fax: 410-943-3976
Mailing address:
  • Phone: 800-344-6423
  • Fax: 410-943-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number15773
License Number StateMD

VIII. Authorized Official

Name: PHYLISS JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 18003446423