| Powell Recovery Center, Inc. | |
|
16 S Broadway Baltimore MD 21231-1712 | |
| (410) 276-1773 | |
| Not Available |
| Full Name | Powell Recovery Center, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 16 S Broadway, Baltimore, Maryland |
| Authorized Official Name and Position | Kim Krantz Wireman (PRESIDENT/CEO) |
| Authorized Official Contact | 4102761773 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Powell Recovery Center, Inc. 14 S Broadway Baltimore MD 21231-1712 Ph: (410) 276-1773 | Powell Recovery Center, Inc. 16 S Broadway Baltimore MD 21231-1712 Ph: (410) 276-1773 |
| NPI Number | 1952382665 |
|---|---|
| Provider Enumeration Date | 11/09/2005 |
| Last Update Date | 10/08/2021 |
| Certification Date | 10/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952382665 | NPI | - | NPPES |
| 218121500 | Medicaid | MD | |
| 415783400 | Medicaid | MD |
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