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General NPI Number Information
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NPI Number | 1619026432
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Entity Type | Organization
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Legal Business Name | JOPPA HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 623 PULASKI HWY # A
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City | JOPPA
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State | MD
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Zip | 21085-3914
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Country | US
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Telephone | 410-538-5809
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Fax | 410-538-4249
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Provider Business Mailing Address
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Address Line | 623 PULASKI HWY # A
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City | JOPPA
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State | MD
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Zip | 21085-3914
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Country | US
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Telephone | 410-538-5809
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Fax | 410-538-4249
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MR. BRENT GARRETT BOWMAN
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Credential | CAC-AD
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Telephone | 410-259-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 11026
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License Number State | MD
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