# SACRED REBIRTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730066028
- **Authorized official:** ALISE BURROW (CEO)
- **Authorized official phone:** (443) 653-6819

## Contact information

- **Practice address:** 6340 SECURITY BLVD STE 100, BALTIMORE, MD 21207-5284
- **Practice address phone:** (443) 653-6819
- **Mailing address:** 6340 SECURITY BLVD STE 100, BALTIMORE, MD 21207-5284
- **Mailing address phone:** (443) 653-6819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 171W00000X | Contractor | — | NULL | — |
| 171W00000X | Contractor | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 08/19/2025
- **Last updated:** 09/19/2025