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General NPI Number Information
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NPI Number | 1205640844
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Entity Type | Organization
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Legal Business Name | PRODUCE OPPORTUNITIES WHICH EMBRACE REHABILITATION POWER LLC
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 2914 KILDAIRE DR
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City | PARKVILLE
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State | MD
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Zip | 21234-7639
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Country | US
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Telephone | 410-240-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ROLLWIN RD
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City | WINDSOR MILL
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State | MD
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Zip | 21244-2835
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Country | US
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Telephone | 410-240-4174
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOELLE G. JOHNSON
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Credential | LCPC
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Telephone | 410-240-4174
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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 |
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License Number State |
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