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General NPI Number Information
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NPI Number | 1073029120
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Entity Type | Organization
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Legal Business Name | REFRESH RECOVERY CENTER
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 5009 BEAUFORT AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5818
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Country | US
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Telephone | 443-562-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 3627 VALLEY TER
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City | WINDSOR MILL
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State | MD
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Zip | 21244-3209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DAVID NDEGWA
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Credential |
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Telephone | 443-562-0147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 247000000X
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Taxonomy Name | Health Information Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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