Provider Demographics
NPI:1124650940
Name:REHABILITATION CENTER FOR HUMANITY LLC
Entity type:Organization
Organization Name:REHABILITATION CENTER FOR HUMANITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-262-9889
Mailing Address - Street 1:4200 EDMONDSON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1600
Mailing Address - Country:US
Mailing Address - Phone:410-262-9889
Mailing Address - Fax:410-510-1681
Practice Address - Street 1:4200 EDMONDSON AVE STE 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1600
Practice Address - Country:US
Practice Address - Phone:410-262-9889
Practice Address - Fax:410-510-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health