Organization
IMPACTFUL CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARIKA DAVENPORT (CEO)
(443) 473-3416
Entity
Organization
Contact information
Practice address
2235 W SARATOGA ST, BALTIMORE, MD 21223-1509
(443) 473-3416
Mailing address
2235 W SARATOGA ST, BALTIMORE, MD 21223-1509
(443) 473-3416
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
06/18/2021
Last updated
09/06/2023
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