Provider Demographics
NPI:1578612891
Name:JEWISH ADDICTION SERVICES
Entity Type:Organization
Organization Name:JEWISH ADDICTION SERVICES
Other - Org Name:JEWISH BIG BROTHER BIG SISTER LEAGUE
Other - Org Type:Other Name
Authorized Official - Title/Position:RECOVERY SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:410-843-7452
Mailing Address - Street 1:5750 PARK HEIGHTS AVE
Mailing Address - Street 2:SUITE 286
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3930
Mailing Address - Country:US
Mailing Address - Phone:410-843-7575
Mailing Address - Fax:410-484-3003
Practice Address - Street 1:5750 PARK HEIGHTS AVE
Practice Address - Street 2:SUITE 286
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3930
Practice Address - Country:US
Practice Address - Phone:410-843-7575
Practice Address - Fax:410-484-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15588261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAK40OtherPROVIDER TYPE NUMBER