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General NPI Number Information
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NPI Number | 1093187874
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Entity Type | Organization
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Legal Business Name | HARBOR OF GRACE ENHANCED RECOVERY CENTER
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 437 GIRARD ST
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City | HAVRE DE GRACE
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State | MD
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Zip | 21078-3215
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Country | US
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Telephone | 443-502-8606
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Fax | 443-502-8598
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Provider Business Mailing Address
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Address Line | 402 MARVEL CT
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City | EASTON
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State | MD
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Zip | 21601-4052
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Country | US
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Telephone | 443-502-8606
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. WILLIAM DAVID HILL
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Credential | D.D.S.
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Telephone | 410-725-6919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 100697
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 100696
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License Number State | MD
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