Healthcare Provider Details

I. General information

NPI: 1144338773
Provider Name (Legal Business Name): THE TRAINING ROOM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BELLONA AVE
TOWSON MD
21204-2012
US

IV. Provider business mailing address

8322 BELLONA AVE
TOWSON MD
21204-2012
US

V. Phone/Fax

Practice location:
  • Phone: 410-321-1126
  • Fax: 410-374-5000
Mailing address:
  • Phone: 410-321-1126
  • Fax: 410-374-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number03186312
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. TRISH MICHIE KOONTZ
Title or Position: CONTRACT MANAGER
Credential:
Phone: 410-374-4000