Provider Demographics
NPI:1164184339
Name:STEP BY STEP OF MARYLAND
Entity Type:Organization
Organization Name:STEP BY STEP OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAJUAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-744-5200
Mailing Address - Street 1:5616 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3969
Mailing Address - Country:US
Mailing Address - Phone:410-744-5200
Mailing Address - Fax:443-708-4500
Practice Address - Street 1:3616 GWYNN OAK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7631
Practice Address - Country:US
Practice Address - Phone:410-744-5200
Practice Address - Fax:443-708-4500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEP BY STEP OF MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility