Healthcare Provider Details

I. General information

NPI: 1124202221
Provider Name (Legal Business Name): WARWICK MANOR BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
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 Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number16294
License Number StateMD

VIII. Authorized Official

Name: MR. L. WESLEY FUHRMAN
Title or Position: PRESIDENT & C.E.O.
Credential:
Phone: 18003446423