Healthcare Provider Details

I. General information

NPI: 1366819187
Provider Name (Legal Business Name): WINDRUSH BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 YORK ROAD SUITE 506
LUTHERVILLE MD
21093-6022
US

IV. Provider business mailing address

1447 YORK ROAD SUITE 506
LUTHERVILLE MD
21093-6022
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-2281
  • Fax: 410-825-2280
Mailing address:
  • Phone: 410-825-2281
  • Fax: 410-825-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD31176
License Number StateMD

VIII. Authorized Official

Name: EDWARD M. SWANTON
Title or Position: CEO/GERIATRIC PSYCHIATRIST
Credential: M.D.
Phone: 410-825-2281