Provider Demographics
NPI:1710425020
Name:THE BALTIMORE STATION
Entity Type:Organization
Organization Name:THE BALTIMORE STATION
Other - Org Name:BAKER STREET STATION
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FRIEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-752-4454
Mailing Address - Street 1:140 W WEST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3739
Mailing Address - Country:US
Mailing Address - Phone:410-752-4454
Mailing Address - Fax:410-752-4123
Practice Address - Street 1:1611 BAKER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2363
Practice Address - Country:US
Practice Address - Phone:410-752-4454
Practice Address - Fax:410-462-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD-10287401324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility