Provider Demographics
NPI:1851984256
Name:CITYWIDE BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CITYWIDE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-274-8388
Mailing Address - Street 1:17 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5334
Mailing Address - Country:US
Mailing Address - Phone:410-274-8388
Mailing Address - Fax:
Practice Address - Street 1:2137 N PULASKI ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1324
Practice Address - Country:US
Practice Address - Phone:410-274-8388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility