=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457376972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUMANIM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6355 WOODSIDE CT
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-381-7171
-----------------------------------------------------
Fax | 410-381-5137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 64275
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21264-4275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-381-7171
-----------------------------------------------------
Fax | 410-381-5137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VDIRECTOR OF BILLING
-----------------------------------------------------
Name | GALE BRITTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-381-7171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------