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General NPI Number Information
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NPI Number | 1841829892
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Entity Type | Organization
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Legal Business Name | CMDS RESIDENTIAL
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 15 S FULTON AVE
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City | BALTIMORE
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State | MD
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Zip | 21223-2306
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Country | US
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Telephone | 410-868-5638
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Fax |
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Provider Business Mailing Address
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Address Line | 5307 AERIE CT
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1103
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Country | US
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Telephone | 240-447-6870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN KARL PFEFFER
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Credential |
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Telephone | 240-447-6870
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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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