MEDICARE: LEADS RECOVERY CENTER LLC

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	:	1972372704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEADS RECOVERY CENTER LLC

Provider Business Mailing Address
First Line	:	3820 CHATHAM RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5410
Country	:	US
Telephone Number	:	443-625-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 CHATHAM RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-5410
Country	:	US
Telephone Number	:	443-475-0058
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	SYLVANUS MENSAH
Credential	:	DNP, AGNP
Telephone Number	:	443-625-3006

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	12/27/2024

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Directions to “LEADS RECOVERY CENTER LLC ” Practice Location

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