Provider Demographics
NPI:1023698362
Name:FAMILYCHOICE CLINIC LLC
Entity type:Organization
Organization Name:FAMILYCHOICE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET T
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-825-2955
Mailing Address - Street 1:5513 YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3804
Mailing Address - Country:US
Mailing Address - Phone:667-212-2682
Mailing Address - Fax:443-835-1446
Practice Address - Street 1:5513 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3804
Practice Address - Country:US
Practice Address - Phone:443-825-2955
Practice Address - Fax:667-212-2682
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILYCHOICE CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-12
Last Update Date:2023-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder