Healthcare Provider Details

I. General information

NPI: 1780733501
Provider Name (Legal Business Name): METWORK HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 LIBERTY RD
ELDERSBURG MD
21784-6723
US

IV. Provider business mailing address

2120 LIBERTY RD
ELDERSBURG MD
21784-6723
US

V. Phone/Fax

Practice location:
  • Phone: 410-781-4158
  • Fax: 410-781-4801
Mailing address:
  • Phone: 410-781-4158
  • Fax: 410-781-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number15858
License Number StateMD

VIII. Authorized Official

Name: MR. BRENT GARRETT BOWMAN
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: CAC-AD
Phone: 410-259-4985