Organization
SECOND MILE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CASTEEL JOHNSON (CEO)
(443) 224-5057
Entity
Organization
Contact information
Practice address
6801 GOLDEN RING RD, ROSEDALE, MD 21237-2104
(443) 224-5057
Mailing address
104 E 25TH ST, BALTIMORE, MD 21218-5252
(443) 224-5057
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/07/2024
Last updated
11/07/2024
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