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General NPI Number Information
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NPI Number | 1205510146
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Entity Type | Organization
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Legal Business Name | MARYLAND SOAR, L.L.C.
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 07/06/2023
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Provider Practice Location Address
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Address Line | 6100 BALTIMORE NATIONAL PIKE STE B05-07
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City | CATONSVILLE
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State | MD
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Zip | 21228-2911
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Country | US
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Telephone | 240-825-9534
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 BALTIMORE NATIONAL PIKE STE B-05
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City | CATONSVILLE
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State | MD
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Zip | 21228-2911
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Country | US
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Telephone | 240-825-9534
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/CEO
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Name | LEE GOODE
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Credential |
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Telephone | 240-825-9534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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