Provider Demographics
NPI:1679556559
Name:INSTITUTES FOR BEHAVIOR RESOURCES, INC.
Entity type:Organization
Organization Name:INSTITUTES FOR BEHAVIOR RESOURCES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VELEKA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:ESTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:410-752-6080
Mailing Address - Street 1:2104 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5612
Mailing Address - Country:US
Mailing Address - Phone:410-752-6080
Mailing Address - Fax:410-889-5810
Practice Address - Street 1:2104 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5612
Practice Address - Country:US
Practice Address - Phone:410-752-6080
Practice Address - Fax:410-889-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR10168523261QM2800X
MD334093261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD236101901Medicaid