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General NPI Number Information
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NPI Number | 1669188991
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Entity Type | Organization
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Legal Business Name | AOLAT TREATMENT PLACE, INC.
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 1725 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21231-2573
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Country | US
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Telephone | 410-469-9786
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21231-2573
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Country | US
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Telephone | 410-469-9786
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FALILU AGBJE
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Credential | BSC, CPI, MHS
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Telephone | 718-902-5659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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