Provider Demographics
NPI:1609651702
Name:MARYLAND SOAR, L.L.C.
Entity Type:Organization
Organization Name:MARYLAND SOAR, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-825-9534
Mailing Address - Street 1:6100 BALTIMORE NATIONAL PIKE STE B05-07
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2911
Mailing Address - Country:US
Mailing Address - Phone:240-825-9534
Mailing Address - Fax:
Practice Address - Street 1:6100 BALTIMORE NATIONAL PIKE STE B05-07
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2911
Practice Address - Country:US
Practice Address - Phone:240-825-9534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health