| Game To Glory Restore | |
|
413 Main St Ste 2 Laurel MD 20707-7101 | |
| (240) 338-2534 | |
| Not Available |
| Full Name | Game To Glory Restore |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 413 Main St Ste 2, Laurel, Maryland |
| Authorized Official Name and Position | Kevin Williams (DIRECTOR) |
| Authorized Official Contact | 2403382534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Game To Glory Restore 4405 Largo Rd Upper Marlboro MD 20772-7837 Ph: (240) 338-2534 | Game To Glory Restore 413 Main St Ste 2 Laurel MD 20707-7101 Ph: (240) 338-2534 |
| NPI Number | 1952082331 |
|---|---|
| Provider Enumeration Date | 07/27/2023 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952082331 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | (* (Not Available)) | Secondary |
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