Healthcare Provider Details

I. General information

NPI: 1730966169
Provider Name (Legal Business Name): FREE BALTIMORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

1120 N CHARLES ST STE 303
BALTIMORE MD
21201-5592
US

V. Phone/Fax

Practice location:
  • Phone: 240-229-6417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NORTHWEST REGISTERED AGENT
Title or Position: REGISTERED AGENT
Credential:
Phone: 509-768-2249