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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
BAS TYSION EL (DIRECTOR)
(301) 741-1316
Entity
Organization

Contact information

Practice address
6016 OLD SILVER HILL RD, DISTRICT HEIGHTS, MD 20747-2110
(301) 741-1316
Mailing address
6016 OLD SILVER HILL RD, DISTRICT HEIGHTS, MD 20747-2110
(301) 741-1316

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
DU36482
MD

Other

Enumeration date
01/12/2016
Last updated
01/12/2016
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