| Jhbmc Adult Voc/ Child Rehab, Off Site/crossroads/variety, Off Site | |
|
4940 Eastern Ave D 3, East Baltimore MD 21224-2735 | |
| (410) 550-0070 | |
| (410) 550-1061 |
| Full Name | Jhbmc Adult Voc/ Child Rehab, Off Site/crossroads/variety, Off Site |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4940 Eastern Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Ronald J Werthman (VPFINANCE, TREASURER, CFO JHHS) |
| Authorized Official Contact | 4109556552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jhbmc Adult Voc/ Child Rehab, Off Site/crossroads/variety, Off Site Po Box 632053 Baltimore MD 21263-2053 Ph: (443) 997-0001 | Jhbmc Adult Voc/ Child Rehab, Off Site/crossroads/variety, Off Site 4940 Eastern Ave D 3, East Baltimore MD 21224-2735 Ph: (410) 550-0070 |
| NPI Number | 1093912388 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 12/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093912388 | NPI | - | NPPES |
| 588531100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 30-005 (Maryland) | Primary |
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