Provider Demographics
NPI:1790325645
Name:BEL AIR RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:BEL AIR RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRATZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-925-3514
Mailing Address - Street 1:1344 GOOSE NECK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-4027
Mailing Address - Country:US
Mailing Address - Phone:410-925-3514
Mailing Address - Fax:
Practice Address - Street 1:2014 S TOLLGATE RD STE 106
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5906
Practice Address - Country:US
Practice Address - Phone:443-402-0612
Practice Address - Fax:443-402-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone