Provider Demographics
NPI:1275877870
Name:TIME ORGANIZATION, INC
Entity Type:Organization
Organization Name:TIME ORGANIZATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:434-250-5784
Mailing Address - Street 1:2901 DRUID PARK DR
Mailing Address - Street 2:SUITE A202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-8102
Mailing Address - Country:US
Mailing Address - Phone:410-225-0062
Mailing Address - Fax:410-225-0184
Practice Address - Street 1:7310 RITCHIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3170
Practice Address - Country:US
Practice Address - Phone:434-704-1082
Practice Address - Fax:434-749-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1146251S00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408791700Medicaid
MD421961900Medicaid