Provider Demographics
NPI:1083312458
Name:PASSION CARE TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:PASSION CARE TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONKE
Authorized Official - Middle Name:FUNKE
Authorized Official - Last Name:IZIOGO
Authorized Official - Suffix:
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:443-536-8014
Mailing Address - Street 1:218 E LEXINGTON ST STE 602&603
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3532
Mailing Address - Country:US
Mailing Address - Phone:443-536-8014
Mailing Address - Fax:
Practice Address - Street 1:218 E LEXINGTON ST STE 602&603
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3532
Practice Address - Country:US
Practice Address - Phone:443-536-8014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder