Provider Demographics
NPI:1477219269
Name:CREATED FOR GREATER HEALTH SYSTEMS
Entity Type:Organization
Organization Name:CREATED FOR GREATER HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC
Authorized Official - Phone:443-315-5007
Mailing Address - Street 1:5411 OLD FREDERICK RD STE 9
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2126
Mailing Address - Country:US
Mailing Address - Phone:443-315-5007
Mailing Address - Fax:
Practice Address - Street 1:5411 OLD FREDERICK RD STE 9
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2126
Practice Address - Country:US
Practice Address - Phone:443-315-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREATED FOR GREATER HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200309704Medicaid