Provider Demographics
NPI:1942533773
Name:BARSTOW ACRES CHILDREN CENTER
Entity Type:Organization
Organization Name:BARSTOW ACRES CHILDREN CENTER
Other - Org Name:PSYCHIATRIC REHABILIATION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:DELICIA
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:410-414-9901
Mailing Address - Street 1:590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3346
Mailing Address - Country:US
Mailing Address - Phone:410-414-9901
Mailing Address - Fax:410-414-9902
Practice Address - Street 1:590 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3346
Practice Address - Country:US
Practice Address - Phone:410-414-9901
Practice Address - Fax:410-414-9902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARSTOW ACRES CHILDREN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-11
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR071676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417174800Medicaid