Provider Demographics
NPI:1194796615
Name:EAST BALTIMORE COMMUNITY CORPORATION / REFLECTIVE TREATMENT CENTER
Entity type:Organization
Organization Name:EAST BALTIMORE COMMUNITY CORPORATION / REFLECTIVE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:BROTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-727-7400
Mailing Address - Street 1:301 N GAY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4813
Mailing Address - Country:US
Mailing Address - Phone:410-752-3500
Mailing Address - Fax:410-528-1005
Practice Address - Street 1:301 N GAY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4831
Practice Address - Country:US
Practice Address - Phone:410-752-3500
Practice Address - Fax:410-528-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD316811101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD733530000Medicaid