MEDICARE: MARIAN HOUSE, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1801573936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAN HOUSE, INC.

Provider Business Mailing Address
First Line	:	949 GORSUCH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-3602
Country	:	US
Telephone Number	:	410-467-4121
Fax Number	:	410-467-6709

Provider Business Practice Location Address
First Line	:	4101 OLD YORK RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-1237
Country	:	US
Telephone Number	:	410-467-4121
Fax Number	:	410-467-6709

Authorized Official
Title or Position	:	EXDECUTIVE DIRECTOR
Name	:	KATHERINE DINEEN ALLSTON
Credential	:	LCSW-C
Telephone Number	:	410-467-4121

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	09/12/2023

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Directions to “MARIAN HOUSE, INC. ” Practice Location

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