Healthcare Provider Details

I. General information

NPI: 1083918940
Provider Name (Legal Business Name): WARWICK MANOR BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E MAIN ST STE A
SALISBURY MD
21801-5044
US

IV. Provider business mailing address

220 E MAIN ST STE A
SALISBURY MD
21801-5044
US

V. Phone/Fax

Practice location:
  • Phone: 410-860-9600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSC1659
License Number StateMD

VIII. Authorized Official

Name: TARA CLENDANIEL
Title or Position: COUNSELOR
Credential: CSC-AD
Phone: 410-860-9600