Healthcare Provider Details

I. General information

NPI: 1083453377
Provider Name (Legal Business Name): MULLIGAN SOBER HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 FRANKLIN AVE
WESTMINSTER MD
21157-5917
US

IV. Provider business mailing address

1535 OLD TANEYTOWN RD
WESTMINSTER MD
21158-3655
US

V. Phone/Fax

Practice location:
  • Phone: 443-463-7806
  • Fax:
Mailing address:
  • Phone: 443-463-7806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: HELEN MCCALL
Title or Position: PRESIDENT
Credential:
Phone: 443-463-7806