Provider Demographics
NPI:1073526711
Name:TOTAL IMAGE CARE INC
Entity Type:Organization
Organization Name:TOTAL IMAGE CARE INC
Other - Org Name:IMAGE RECOVERY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:410-342-9484
Mailing Address - Street 1:800 ARMY ROAD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-342-9484
Mailing Address - Fax:410-342-9486
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:IMAGE RECOVERY CENTER AT SINAI HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-4725
Practice Address - Fax:440-601-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCF807OtherBLUE CROSS
MDMH24OtherBLUE CROSS
MDMH24OtherBLUE CROSS