1093351678 NPI number — CECIL COMMUNITY RECOVERY CENTER LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093351678 NPI number — CECIL COMMUNITY RECOVERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CECIL COMMUNITY RECOVERY CENTER LLC
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:
Provider Other Organization Name Type Code:
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:
1093351678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 SLADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-4907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-352-8622
Provider Business Mailing Address Fax Number:
443-450-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409/411 W PULASKI HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-904-3423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GLAZER
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
443-352-8622

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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