1376997544 NPI number — POSITIVE STEPS LLC SUBSTANCE ABUSE

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 1376997544 NPI number — POSITIVE STEPS LLC SUBSTANCE ABUSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POSITIVE STEPS LLC SUBSTANCE ABUSE
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:
1376997544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5710 BELLONA AVE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21212-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-878-6404
Provider Business Mailing Address Fax Number:
410-779-9147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5710 BELLONA AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-878-6404
Provider Business Practice Location Address Fax Number:
410-779-9147
Provider Enumeration Date:
04/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WILLOUGHBY
Authorized Official First Name:
TYRONE
Authorized Official Middle Name:
Authorized Official Title or Position:
QA DIRECTOR
Authorized Official Telephone Number:
410-353-8954

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  100725 , 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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