Organization
POWELL RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAYTHE MOYER (BILLING DIRECTOR)
(443) 974-3027
Entity
Organization
Contact information
Practice address
832 E BALTIMORE ST, BALTIMORE, MD 21202-4702
(410) 276-1773
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
906064
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
906064
—
MD
Enumeration date
05/30/2017
Last updated
05/30/2017
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