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General NPI Number Information
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NPI Number | 1417810771
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Entity Type | Organization
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Legal Business Name | LIBERTY HEIGHTS WABASH DOLFIELD CONSOLIDATED TRUST CDC INC
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Dates
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Enumeration Date | 12/04/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 4003 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21207-7545
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Country | US
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Telephone | 443-467-6801
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Fax |
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Provider Business Mailing Address
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Address Line | 4003 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21207-7545
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Country | US
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Telephone | 443-467-6801
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. DUANE ALEXANDER
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Credential | PRP, YOUNG CHILD ED,
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Telephone | 443-467-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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Taxonomy #6
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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