Provider Demographics
NPI:1104366640
Name:ON THE FLIP SIDE, INC.
Entity Type:Organization
Organization Name:ON THE FLIP SIDE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, CCM
Authorized Official - Phone:410-831-2138
Mailing Address - Street 1:PO BOX 32633
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-2633
Mailing Address - Country:US
Mailing Address - Phone:410-831-2138
Mailing Address - Fax:
Practice Address - Street 1:3739 WILKENS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5035
Practice Address - Country:US
Practice Address - Phone:410-831-2138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16681251300000X, 251S00000X
MD4221133251B00000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251300000XAgenciesLocal Education Agency (LEA)
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility