Healthcare Provider Details

I. General information

NPI: 1467501544
Provider Name (Legal Business Name): WARWICK MANOR BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220A E MAIN ST
SALISBURY MD
21801-4923
US

IV. Provider business mailing address

3680 WARWICK RD
EAST NEW MARKET MD
21631-1420
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-9600
  • Fax:
Mailing address:
  • Phone: 180-034-4642
  • Fax: 410-943-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16295
License Number StateMD

VIII. Authorized Official

Name: PHYLISS JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 18003446423