Provider Demographics
NPI:1043947732
Name:BEYOND THERAPEUTIC GROUNDS
Entity Type:Organization
Organization Name:BEYOND THERAPEUTIC GROUNDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-831-1331
Mailing Address - Street 1:326 SAINT PAUL ST STE 300A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 SAINT PAUL ST STE 300A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2201
Practice Address - Country:US
Practice Address - Phone:443-836-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health