Provider Demographics
NPI:1568443208
Name:SOUTH BALTINORE C.A.P. INC.
Entity Type:Organization
Organization Name:SOUTH BALTINORE C.A.P. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC-AD
Authorized Official - Phone:410-752-2475
Mailing Address - Street 1:1435 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4438
Mailing Address - Country:US
Mailing Address - Phone:410-752-2475
Mailing Address - Fax:410-385-1466
Practice Address - Street 1:1435 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4438
Practice Address - Country:US
Practice Address - Phone:410-752-2475
Practice Address - Fax:410-385-1466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11174324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility