Organization
MAN ALIVE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN REESE M.A., CAC-AD (EXECUTIVE DIRECTOR)
(410) 837-4292
Entity
Organization
Contact information
Practice address
2117 MARYLAND AVE, BALTIMORE, MD 21218-5614
(410) 837-4292
(410) 837-0639
Mailing address
2117 MARYLAND AVE, BALTIMORE, MD 21218-5614
(410) 837-4292
(410) 837-0639
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
900128
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57387001
CAREFIRST BCBS
MD
Enumeration date
11/08/2005
Last updated
08/22/2020
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