Provider Demographics
NPI:1760873632
Name:HARWOOD BEHAVIORAL HEALTH PARTNERS, LLC
Entity Type:Organization
Organization Name:HARWOOD BEHAVIORAL HEALTH PARTNERS, LLC
Other - Org Name:CCG BALTIMORE
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OPERATIONS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:667-239-3205
Mailing Address - Street 1:428 E 25TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5304
Mailing Address - Country:US
Mailing Address - Phone:410-617-0142
Mailing Address - Fax:443-873-6975
Practice Address - Street 1:428 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5304
Practice Address - Country:US
Practice Address - Phone:410-617-0142
Practice Address - Fax:443-873-6975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CCG MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-12
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251B00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD534204000Medicaid