Provider Demographics
NPI:1407007289
Name:4 WALLS HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:4 WALLS HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:GIBSON-JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-AD
Authorized Official - Phone:443-762-6949
Mailing Address - Street 1:6609 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2315
Mailing Address - Country:US
Mailing Address - Phone:443-762-6949
Mailing Address - Fax:
Practice Address - Street 1:6609 REISTERSTOWN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2315
Practice Address - Country:US
Practice Address - Phone:443-762-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)