| Powell Recovery Center, Inc. | |
|
14 S Broadway Baltimore MD 21231-1712 | |
| (410) 276-1773 | |
| (410) 276-2056 |
| Full Name | Powell Recovery Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 14 S Broadway, Baltimore, Maryland |
| Authorized Official Name and Position | Kim Wireman (PRESIDENT/CEO) |
| Authorized Official Contact | 4436101455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Powell Recovery Center, Inc. 14 S Broadway Baltimore MD 21231-1712 Ph: (410) 276-1773 | Powell Recovery Center, Inc. 14 S Broadway Baltimore MD 21231-1712 Ph: (410) 276-1773 |
| NPI Number | 1699928994 |
|---|---|
| Provider Enumeration Date | 10/30/2008 |
| Last Update Date | 08/12/2024 |
| Certification Date | 08/12/2024 |
| Medicare PECOS PAC ID | 0244323145 |
|---|---|
| Medicare Enrollment ID | O20070910000225 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699928994 | NPI | - | NPPES |
| 218121500 | Medicaid | MD |
| Provider Name | Kimberly K Wireman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437304862 PECOS PAC ID: 0648336545 Enrollment ID: I20090302000116 |
| Provider Name | Alex Leland Goldberg |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992225452 PECOS PAC ID: 8123567062 Enrollment ID: I20240823000994 |
| Provider Name | Bridget Louise Perry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093162448 PECOS PAC ID: 0143769919 Enrollment ID: I20240823002596 |
| Provider Name | Bryant Earl Dooley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912372376 PECOS PAC ID: 4082153861 Enrollment ID: I20240823002966 |
| Provider Name | Maricela Cast |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285049858 PECOS PAC ID: 7315486198 Enrollment ID: I20240823003131 |
| Provider Name | Renee Ann Liebnow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225687387 PECOS PAC ID: 6901346188 Enrollment ID: I20240914000309 |
| Provider Name | Faythe Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821302720 PECOS PAC ID: 4385175504 Enrollment ID: I20240930000341 |
| Provider Name | Angelise A Shelby |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083193502 PECOS PAC ID: 4587195540 Enrollment ID: I20241001002276 |
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