Provider Demographics
NPI:1124557871
Name:ADDIS CONSULTING INC.
Entity Type:Organization
Organization Name:ADDIS CONSULTING INC.
Other - Org Name:FRESH START COMPREHENSIVE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-884-7521
Mailing Address - Street 1:11 E MOUNT ROYAL AVE STE LL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8492 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3370
Practice Address - Country:US
Practice Address - Phone:443-671-1414
Practice Address - Fax:443-671-1420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDIS CONSULTING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424075801Medicaid