MEDICARE: TUERK HOUSE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1083372239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUERK HOUSE, INC

Provider Business Mailing Address
First Line	:	2701 N CHARLES ST STE 200
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4351
Country	:	US
Telephone Number	:	667-212-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	5212 GWYNN OAK AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6807
Country	:	US
Telephone Number	:	667-212-3626
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	VANESSA LYLE
Credential	:
Telephone Number	:	667-212-3626

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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Directions to “TUERK HOUSE, INC ” Practice Location

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