Organization
LGTULA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA YVETTE JACKSON (SURROGATE)
(443) 418-4254
Entity
Organization
Contact information
Practice address
1515 N BENTALOU ST, BALTIMORE, MD 21216-4120
(410) 702-0510
Mailing address
1515 N BENTALOU ST, BALTIMORE, MD 21216-4120
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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