Provider Demographics
NPI:1639881782
Name:KINDRED TREATMENT CENTER
Entity Type:Organization
Organization Name:KINDRED TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CAC-AD
Authorized Official - Phone:443-683-0069
Mailing Address - Street 1:2855 COUNTRY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2091
Mailing Address - Country:US
Mailing Address - Phone:443-683-0069
Mailing Address - Fax:
Practice Address - Street 1:3000 MANCHESTER RD STE B
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1850
Practice Address - Country:US
Practice Address - Phone:410-861-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED TREATMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD881329900Medicaid