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General NPI Number Information
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NPI Number | 1467275347
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Entity Type | Organization
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Legal Business Name | SECOND MILE SERVICES, LLC
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Dates
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Enumeration Date | 11/07/2024
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 6801 GOLDEN RING RD
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City | ROSEDALE
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State | MD
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Zip | 21237-2104
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Country | US
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Telephone | 443-224-5057
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E 25TH ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5252
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Country | US
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Telephone | 443-224-5057
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CASTEEL JOHNSON
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Credential |
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Telephone | 443-224-5057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #9
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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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License Number State |
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