Provider Demographics
NPI:1972218725
Name:ADDICTION TREATMENT OF MARYLAND
Entity Type:Organization
Organization Name:ADDICTION TREATMENT OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMEMMO
Authorized Official - Suffix:
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:443-376-6800
Mailing Address - Street 1:9 CENTER PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 HORNEL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2805
Practice Address - Country:US
Practice Address - Phone:443-676-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION TREATMENT OF MARYLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNONEMedicaid