Provider Demographics
NPI:1689454266
Name:RESTORATIVE TREATMENT SERVICES
Entity Type:Organization
Organization Name:RESTORATIVE TREATMENT SERVICES
Other - Org Name:RTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COREA
Authorized Official - Middle Name:CHARLISE
Authorized Official - Last Name:MITTER BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-226-3906
Mailing Address - Street 1:1200 N COLLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-3313
Mailing Address - Country:US
Mailing Address - Phone:443-226-3906
Mailing Address - Fax:
Practice Address - Street 1:1200 N COLLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-3313
Practice Address - Country:US
Practice Address - Phone:443-226-3906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility