Healthcare Provider Details

I. General information

NPI: 1679321954
Provider Name (Legal Business Name): ADDICTION TREATMENT OF MARYLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 211TH ST
PASADENA MD
21122-1435
US

IV. Provider business mailing address

9 CENTER PL
BALTIMORE MD
21222-4362
US

V. Phone/Fax

Practice location:
  • Phone: 443-376-6800
  • Fax:
Mailing address:
  • Phone: 443-376-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISSY DIMEMMO
Title or Position: COO
Credential:
Phone: 443-376-6800