Provider Demographics
NPI:1215587027
Name:SIBUS TREATMENT SERVICES LLC
Entity Type:Organization
Organization Name:SIBUS TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-991-5687
Mailing Address - Street 1:6170 HUNT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5518
Mailing Address - Country:US
Mailing Address - Phone:443-820-3234
Mailing Address - Fax:
Practice Address - Street 1:6170 HUNT CLUB RD
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-0003
Practice Address - Country:US
Practice Address - Phone:443-820-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIBUS TREATMENT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone