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General NPI Number Information
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NPI Number | 1578754438
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Entity Type | Organization
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Legal Business Name | FOUNDATIONS PSYCHIATRIC REHABILITATION PROGRAM
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 1025 W NURSERY RD SUITE 118
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City | LINTHICUM
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State | MD
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Zip | 21090-1205
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Country | US
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Telephone | 410-789-7772
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Fax | 410-789-7177
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Provider Business Mailing Address
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Address Line | 1025 W NURSERY RD SUITE 118
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City | LINTHICUM
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State | MD
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Zip | 21090-1205
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Country | US
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Telephone | 410-789-7772
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Fax | 410-789-7177
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. CHRIS E MORRIS
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Credential |
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Telephone | 410-789-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 18660
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License Number State | MD
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