Organization
ISSIAIH HOUSE 1
Active
Parent organization
ISSAIAH HOUSE
Other names
Issaiah House 1
Organization subpart
Yes
Provider details
NPI number
Legal business name
ISSAIAH HOUSE
Authorized official
MR. DARRYL EDWARD BRAXTON LCPC, LCADC (DIRECTOR)
(443) 882-1943
Entity
Organization
Contact information
Practice address
2802 HARFORD RD, BALTIMORE, MD 21218-4953
(443) 882-1943
(410) 558-6222
Mailing address
919 CALWELL RD, BALTIMORE, MD 21229-5006
(443) 882-1943
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH000372
MD
Other
Enumeration date
07/19/2018
Last updated
06/14/2019
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