Provider Demographics
NPI:1124404421
Name:WINDRUSH BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:WINDRUSH BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/GERIATRIC PHYSIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWANTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-825-2281
Mailing Address - Street 1:1447 YORK ROAD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6022
Mailing Address - Country:US
Mailing Address - Phone:410-825-2281
Mailing Address - Fax:410-825-2280
Practice Address - Street 1:1447 YORK ROAD
Practice Address - Street 2:SUITE 506
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6022
Practice Address - Country:US
Practice Address - Phone:410-825-2281
Practice Address - Fax:410-825-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173000000X
MDD31176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty