Provider Demographics
NPI:1972102879
Name:AMAZIN RECOVERY TREATMENT SERVICES LLC
Entity Type:Organization
Organization Name:AMAZIN RECOVERY TREATMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:443-376-5785
Mailing Address - Street 1:6730 HOLABIRD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1700
Mailing Address - Country:US
Mailing Address - Phone:443-376-5785
Mailing Address - Fax:
Practice Address - Street 1:6730 HOLABIRD AVE STE 201
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1700
Practice Address - Country:US
Practice Address - Phone:443-376-5785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZIN RECOVERY TREATMENT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health