Provider Demographics
NPI:1679321954
Name:ADDICTION TREATMENT OF MARYLAND
Entity type:Organization
Organization Name:ADDICTION TREATMENT OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMEMMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-376-6800
Mailing Address - Street 1:9 CENTER PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-4362
Mailing Address - Country:US
Mailing Address - Phone:443-376-6800
Mailing Address - Fax:
Practice Address - Street 1:689 211TH ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1435
Practice Address - Country:US
Practice Address - Phone:443-376-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility