1801945001 NPI number — CLEAN AND SOBER

Table of content: (NPI 1801945001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801945001 NPI number — CLEAN AND SOBER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEAN AND SOBER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALCOHOL AND DRUG RECOVERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801945001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 CRAIN HWY N
Provider Second Line Business Mailing Address:
UNIT C
Provider Business Mailing Address City Name:
GLEN BURNIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21061-3559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-768-5242
Provider Business Mailing Address Fax Number:
410-787-8637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CRAIN HWY N
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
GLEN BURNIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21061-3559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-768-5242
Provider Business Practice Location Address Fax Number:
410-787-8637
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMIDT
Authorized Official First Name:
FRITZ
Authorized Official Middle Name:
LINDROTH
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-268-6800

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  15661 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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