Provider Demographics
NPI:1477244960
Name:CHATFORD MANOR BEHAVIORAL & RESIDENTIAL SERVICES, LLC.
Entity Type:Organization
Organization Name:CHATFORD MANOR BEHAVIORAL & RESIDENTIAL SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-960-1497
Mailing Address - Street 1:8109 HARFORD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9205
Mailing Address - Country:US
Mailing Address - Phone:443-413-0468
Mailing Address - Fax:
Practice Address - Street 1:8517 LOCH RAVEN BLVD STE 3
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2302
Practice Address - Country:US
Practice Address - Phone:443-495-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility