Healthcare Provider Details

I. General information

NPI: 1538902192
Provider Name (Legal Business Name): BALTIMORE CRISIS RESPONSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 06/13/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 EAST OAKLAND STREET
OAKLAND MD
21550
US

IV. Provider business mailing address

5124 GREENWICH AVE
BALTIMORE MD
21229-2314
US

V. Phone/Fax

Practice location:
  • Phone: 410-433-5255
  • Fax: 410-433-6795
Mailing address:
  • Phone: 443-986-0822
  • Fax: 410-433-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CINDY ANN SHAW-WILSON
Title or Position: QUALITY ASSURANCE & COMPLIANCE SPEC
Credential: MA
Phone: 443-986-0822