Provider Demographics
NPI:1073189270
Name:EACH1TEACH1 COMMUNITY HEALTH,LLC
Entity Type:Organization
Organization Name:EACH1TEACH1 COMMUNITY HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM/CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:CAC-AD
Authorized Official - Phone:443-271-2874
Mailing Address - Street 1:3111 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2734
Mailing Address - Country:US
Mailing Address - Phone:443-271-2874
Mailing Address - Fax:
Practice Address - Street 1:3111 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2734
Practice Address - Country:US
Practice Address - Phone:443-271-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health