Provider Demographics
NPI:1821666504
Name:AOLAT TREATMENT PLACE, INC.
Entity Type:Organization
Organization Name:AOLAT TREATMENT PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FALILU
Authorized Official - Middle Name:
Authorized Official - Last Name:AGBJE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, CPI, MHS
Authorized Official - Phone:718-902-5659
Mailing Address - Street 1:1725 EASTERN AVE FL 1/2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2573
Mailing Address - Country:US
Mailing Address - Phone:410-469-9786
Mailing Address - Fax:
Practice Address - Street 1:1725 EASTERN AVE FL 1/2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-2573
Practice Address - Country:US
Practice Address - Phone:410-469-9786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health