Provider Demographics
NPI:1427441880
Name:ADDIS CONSULTING INC.
Entity type:Organization
Organization Name:ADDIS CONSULTING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADDISU
Authorized Official - Middle Name:
Authorized Official - Last Name:MENGESHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-704-4001
Mailing Address - Street 1:1 E MOUNT ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2614
Mailing Address - Country:US
Mailing Address - Phone:443-671-1414
Mailing Address - Fax:443-671-1420
Practice Address - Street 1:11 E MOUNT ROYAL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2714
Practice Address - Country:US
Practice Address - Phone:443-671-1414
Practice Address - Fax:443-671-1420
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH START COMPREHENSIVE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17162261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder