Provider Demographics
NPI:1063044964
Name:THERAPEUTIC LIVING FOR FAMILIES INC
Entity Type:Organization
Organization Name:THERAPEUTIC LIVING FOR FAMILIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NYQUITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-366-1151
Mailing Address - Street 1:3425 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2030
Mailing Address - Country:US
Mailing Address - Phone:410-366-1151
Mailing Address - Fax:410-366-0032
Practice Address - Street 1:3425 SINCLAIR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2030
Practice Address - Country:US
Practice Address - Phone:410-366-1151
Practice Address - Fax:410-366-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200109482Medicaid