Provider Demographics
NPI:1477233302
Name:BLUE DOOR RECOVERY
Entity Type:Organization
Organization Name:BLUE DOOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TYRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-292-5896
Mailing Address - Street 1:2798 QUANTIM CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1894
Mailing Address - Country:US
Mailing Address - Phone:410-292-5896
Mailing Address - Fax:
Practice Address - Street 1:4200 PIMLICO RD UNIT HM
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6910
Practice Address - Country:US
Practice Address - Phone:141-029-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit