Provider Demographics
NPI:1497954275
Name:BALTIMORE CRISIS RESPONSE, INC.
Entity Type:Organization
Organization Name:BALTIMORE CRISIS RESPONSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:MHS
Authorized Official - Phone:410-746-5311
Mailing Address - Street 1:5124 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2314
Mailing Address - Country:US
Mailing Address - Phone:410-433-5255
Mailing Address - Fax:410-433-6795
Practice Address - Street 1:5124 GREENWICH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2314
Practice Address - Country:US
Practice Address - Phone:410-433-5255
Practice Address - Fax:410-433-6795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045540323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406711800Medicaid