Provider Demographics
NPI:1215116470
Name:ATS OF CECIL COUNTY
Entity type:Organization
Organization Name:ATS OF CECIL COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LGSW
Authorized Official - Phone:410-200-5210
Mailing Address - Street 1:6709 WHITESTONE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4103
Mailing Address - Country:US
Mailing Address - Phone:410-265-5415
Mailing Address - Fax:410-298-4702
Practice Address - Street 1:6709 WHITESTONE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4103
Practice Address - Country:US
Practice Address - Phone:410-265-5415
Practice Address - Fax:410-298-4702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATS OF CECIL COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD347205261QM2800X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone