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General NPI Number Information
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NPI Number | 1578095618
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Entity Type | Organization
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Legal Business Name | KEYS DEVELOPMENT TA LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 7501 LIBERTY ROAD SUITES A, B, F/G & L
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City | GWYNN OAK
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State | MD
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Zip | 21207-3870
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Country | US
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Telephone | 443-429-2536
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Fax | 443-429-2168
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Provider Business Mailing Address
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Address Line | 7501 LIBERTY ROAD SUITES A, B, F/G & L
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City | GWYNN OAK
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State | MD
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Zip | 21207-3870
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Country | US
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Telephone | 443-429-2536
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Fax | 443-429-2168
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | ERIKA TRACEY ROBINSON
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Credential |
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Telephone | 443-429-2536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MH-1995
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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