Provider Demographics
NPI:1780317834
Name:CHATFORD MANOR BEHAVIORAL AND RESIDENTIAL SERVICES
Entity type:Organization
Organization Name:CHATFORD MANOR BEHAVIORAL AND RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-960-1497
Mailing Address - Street 1:8109 HARFORD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-9205
Mailing Address - Country:US
Mailing Address - Phone:443-653-0567
Mailing Address - Fax:
Practice Address - Street 1:8109 HARFORD RD STE 2
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-9205
Practice Address - Country:US
Practice Address - Phone:443-653-0567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility