Provider Demographics
NPI:1396314340
Name:GROUNDWORK BEHAVIORAL HEALTH SERVICES CORP
Entity type:Organization
Organization Name:GROUNDWORK BEHAVIORAL HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-831-1331
Mailing Address - Street 1:4713-4715 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 N CARROLLTON AVE APT 1F 1B 2B 2F 3B 3F BASEMENT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2415
Practice Address - Country:US
Practice Address - Phone:443-575-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health