Provider Demographics
NPI:1467501544
Name:WARWICK MANOR BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:WARWICK MANOR BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PHYLISS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1800-344-6423
Mailing Address - Street 1:3680 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:EAST NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21631-1420
Mailing Address - Country:US
Mailing Address - Phone:180-034-4642
Mailing Address - Fax:410-943-3976
Practice Address - Street 1:220A E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4923
Practice Address - Country:US
Practice Address - Phone:410-860-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16295101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty