Provider Demographics
NPI:1720091044
Name:NORTH BALTIMORE CENTER, INC
Entity Type:Organization
Organization Name:NORTH BALTIMORE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-366-4360
Mailing Address - Street 1:2225 N. CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-366-4360
Mailing Address - Fax:410-243-7948
Practice Address - Street 1:2225 N. CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-366-4360
Practice Address - Fax:410-243-7948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YM0800X, 103TC1900X
MD001983101YM0800X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007100500Medicaid
MD266781900Medicaid
MD589061600Medicaid
MD589061600Medicaid