Organization
POWELL RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAYTHE MOYER (BILLING DIRECTOR)
(410) 276-1773
Entity
Organization
Contact information
Practice address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
903742
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6355102-00
—
MD
Enumeration date
07/09/2009
Last updated
07/21/2022
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