Provider Demographics
NPI:1639758337
Name:FREE BALTIMORE, LLC
Entity type:Organization
Organization Name:FREE BALTIMORE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RE
Authorized Official - Prefix:
Authorized Official - First Name:NORTHWEST
Authorized Official - Middle Name:REGISTERED
Authorized Official - Last Name:AGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-416-5667
Mailing Address - Street 1:1120 N CHARLES ST STE 408
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5594
Mailing Address - Country:US
Mailing Address - Phone:443-416-5667
Mailing Address - Fax:443-687-8720
Practice Address - Street 1:1120 N CHARLES ST STE 408
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5594
Practice Address - Country:US
Practice Address - Phone:443-416-5667
Practice Address - Fax:443-687-8720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREE BALTIMORE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-08
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty