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General NPI Number Information
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NPI Number | 1457213100
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Entity Type | Organization
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Legal Business Name | COADVOCATE SPECIALISTS, INC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1055 INGLESIDE AVE STE 100
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City | CATONSVILLE
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State | MD
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Zip | 21228-1337
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Country | US
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Telephone | 443-383-3913
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 INGLESIDE AVE STE 100
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City | CATONSVILLE
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State | MD
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Zip | 21228-1337
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Country | US
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Telephone | 443-383-3913
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LATIA OBANNER
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Credential | RN
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Telephone | 443-383-3913
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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