Provider Demographics
NPI:1457061269
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:CACAS
Authorized Official - Phone:443-376-5785
Mailing Address - Street 1:5610 HARFORD RD # 305-306
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2247
Mailing Address - Country:US
Mailing Address - Phone:443-376-5785
Mailing Address - Fax:
Practice Address - Street 1:5610 HARFORD RD # 305-306
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2247
Practice Address - Country:US
Practice Address - Phone:443-376-5785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health