=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982357042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORLEANS HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2022
-----------------------------------------------------
Last Update Date | 01/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 ORLEANS ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21224-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-779-9909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2833 SMITH AVE STE 148
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-258-8939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM SPONSOR
-----------------------------------------------------
Name | AMIEL CHICHEPORTICHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-484-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------