Healthcare Provider Details

I. General information

NPI: 1295366144
Provider Name (Legal Business Name): TOTAL FAITH RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9448 PARAGON CT
OWINGS MILLS MD
21117-1407
US

IV. Provider business mailing address

9448 PARAGON CT
OWINGS MILLS MD
21117-1407
US

V. Phone/Fax

Practice location:
  • Phone: 202-246-9725
  • Fax:
Mailing address:
  • Phone: 202-246-9725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. EDDIE V FREEMAN
Title or Position: PRESIDENT/FOUNDER
Credential:
Phone: 202-246-9725