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Organization

PHASE TWO RECOVERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CHRISTOPHER HENRY JR. (VICE PRESIDENT)
(410) 301-9162
Entity
Organization

Contact information

Practice address
435 EASTERN BLVD, BALTIMORE, MD 21221-6715
(443) 916-2533
Mailing address
435 EASTERN BLVD, BALTIMORE, MD 21221-6715
(443) 916-2533

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1093250235
MD
Enumeration date
10/17/2017
Last updated
10/17/2017
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