Provider Demographics
NPI:1083949895
Name:SOUTH BALTIMORE C.A.P.
Entity Type:Organization
Organization Name:SOUTH BALTIMORE C.A.P.
Other - Org Name:SAFE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC
Authorized Official - Phone:410-385-1466
Mailing Address - Street 1:7 W RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4429
Mailing Address - Country:US
Mailing Address - Phone:410-385-1466
Mailing Address - Fax:410-385-1466
Practice Address - Street 1:1435 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4438
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:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903613324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility