Provider Demographics
NPI:1386086361
Name:TUERK HOUSE INC
Entity type:Organization
Organization Name:TUERK HOUSE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-233-0684
Mailing Address - Street 1:730 N ASHBURTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-4703
Mailing Address - Country:US
Mailing Address - Phone:410-233-0684
Mailing Address - Fax:410-233-8540
Practice Address - Street 1:730 N ASHBURTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4703
Practice Address - Country:US
Practice Address - Phone:410-233-0684
Practice Address - Fax:410-233-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904732320800000X, 323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024102400Medicaid