MEDICARE: FIRST STEP RECOVERY CENTER, 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	251S00000X	Community/Behavioral Health Agency	LCA026	MD

General Provider Information

NPI Number	:	1710037759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP RECOVERY CENTER, INC.

Provider Business Mailing Address
First Line	:	1419 FOREST DR
Second Line	:	SUITE 104
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1482
Country	:	US
Telephone Number	:	410-280-2333
Fax Number	:	410-280-9866

Provider Business Practice Location Address
First Line	:	1419 FOREST DR
Second Line	:	SUITE 104
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1482
Country	:	US
Telephone Number	:	410-280-2333
Fax Number	:	410-280-9866

Authorized Official
Title or Position	:	CLINICAL DIRECTO
Name	:	MRS. LEIGH S RAGAN
Credential	:	LCADC
Telephone Number	:	410-280-2333

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	12/19/2011

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