Provider Demographics
NPI:1992325302
Name:BUILDING BRIDGES OF BALTIMORE, LLC
Entity type:Organization
Organization Name:BUILDING BRIDGES OF BALTIMORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-978-2317
Mailing Address - Street 1:500 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1997
Mailing Address - Country:US
Mailing Address - Phone:410-978-2317
Mailing Address - Fax:
Practice Address - Street 1:1314 BEDFORD AVE STE 210A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6605
Practice Address - Country:US
Practice Address - Phone:443-744-8994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200409771OtherBEHAVIORAL HEALTH PRP LICENSE NUMBER