Healthcare Provider Details

I. General information

NPI: 1275877870
Provider Name (Legal Business Name): TIME ORGANIZATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 RITCHIE HWY STE 100
GLEN BURNIE MD
21061-3170
US

IV. Provider business mailing address

2901 DRUID PARK DR SUITE A202
BALTIMORE MD
21215-8102
US

V. Phone/Fax

Practice location:
  • Phone: 434-704-1082
  • Fax: 434-749-0221
Mailing address:
  • Phone: 410-225-0062
  • Fax: 410-225-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH-1146
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. LAMONT ANTHONY ELLIS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 434-250-5784