Provider Demographics
NPI:1326521089
Name:MICHAEL'S LOFT RESIDENTIAL PROGRAM
Entity Type:Organization
Organization Name:MICHAEL'S LOFT RESIDENTIAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:443-416-5474
Mailing Address - Street 1:1800 N CHARLES ST STE 904
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5987
Mailing Address - Country:US
Mailing Address - Phone:443-388-9654
Mailing Address - Fax:
Practice Address - Street 1:743 OLD RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MD
Practice Address - Zip Code:21225-2660
Practice Address - Country:US
Practice Address - Phone:443-388-9654
Practice Address - Fax:443-388-9367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit