MEDICARE: ADDICTION RECOVERY SERVICES

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	LCA157	MD
2	251S00000X	Community/Behavioral Health Agency	101YA0400X	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCA157	OTHER	MD	MD LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861620239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION RECOVERY SERVICES

Provider Business Mailing Address
First Line	:	8950 RTE 108
Second Line	:	SUITE 235
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2273
Country	:	US
Telephone Number	:	410-964-2771
Fax Number	:

Provider Business Practice Location Address
First Line	:	8950 RTE 108
Second Line	:	SUITE 235
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2273
Country	:	US
Telephone Number	:	410-964-2771
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	THOMAS PATRICK BENNER
Credential	:	MS, LCADC, MAC, SAP
Telephone Number	:	410-964-2771

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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Directions to “ADDICTION RECOVERY SERVICES ” Practice Location

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