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General NPI Number Information
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NPI Number | 1386620649
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Entity Type | Organization
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Legal Business Name | NORTHWEST BALTIMORE YOUTH SERVICES, INC.
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 3319 W BELVEDERE AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5103
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Country | US
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Telephone | 410-578-8100
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Fax | 443-524-2628
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Provider Business Mailing Address
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Address Line | 3319 W BELVEDERE AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5103
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Country | US
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Telephone | 410-578-8100
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Fax | 443-524-2628
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. AUDREY F. BENNETT
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Credential |
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Telephone | 410-578-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 903676
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License Number State | MD
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