Provider Demographics
NPI:1073037446
Name:SOUTH BALTIMORE C.A.P. INC.
Entity Type:Organization
Organization Name:SOUTH BALTIMORE C.A.P. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CSC-AD
Authorized Official - Phone:301-356-8455
Mailing Address - Street 1:16509 ELDBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-7360
Mailing Address - Country:US
Mailing Address - Phone:301-356-8455
Mailing Address - Fax:410-752-4772
Practice Address - Street 1:7 W RANDALL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4429
Practice Address - Country:US
Practice Address - Phone:410-385-1466
Practice Address - Fax:410-385-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4184084-00Medicaid