Provider Demographics
NPI:1124856216
Name:DIG-IN-TO CHANGE/KNOWLEDGE, POWER AND WISDOM, LLC
Entity type:Organization
Organization Name:DIG-IN-TO CHANGE/KNOWLEDGE, POWER AND WISDOM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COO
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:DIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:CAC-ADS
Authorized Official - Phone:443-602-6531
Mailing Address - Street 1:1401 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5715
Mailing Address - Country:US
Mailing Address - Phone:443-602-6531
Mailing Address - Fax:
Practice Address - Street 1:1401 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5715
Practice Address - Country:US
Practice Address - Phone:410-501-4759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility