Healthcare Provider Details

I. General information

NPI: 1548107584
Provider Name (Legal Business Name): SURVIVAL HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 DAY RD
HAGERSTOWN MD
21740-1225
US

IV. Provider business mailing address

2053 DAY RD
HAGERSTOWN MD
21740-1225
US

V. Phone/Fax

Practice location:
  • Phone: 227-223-5122
  • Fax:
Mailing address:
  • Phone: 227-223-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: KEVIN SHORB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-259-4873