Provider Demographics
NPI:1639837164
Name:PATRICIA'S PLACE INC
Entity Type:Organization
Organization Name:PATRICIA'S PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-468-1816
Mailing Address - Street 1:3234 BELAIR RD FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1228
Mailing Address - Country:US
Mailing Address - Phone:443-468-1816
Mailing Address - Fax:
Practice Address - Street 1:3234 BELAIR RD FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1228
Practice Address - Country:US
Practice Address - Phone:443-468-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICIA'S PLACE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder