Provider Demographics
NPI:1003205907
Name:HOME FREE IOP
Entity Type:Organization
Organization Name:HOME FREE IOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:BRADLEY-POFF
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-225-7696
Mailing Address - Street 1:10 W MADISON ST STE 11
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5239
Mailing Address - Country:US
Mailing Address - Phone:443-438-5239
Mailing Address - Fax:
Practice Address - Street 1:10 W MADISON ST STE 11
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5239
Practice Address - Country:US
Practice Address - Phone:443-438-5239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME FREE IOP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905390251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health