Organization
GRACEFUL PHOENIX RECOVERY HOUSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEYANA JOHNSON CAC-AD (OWNER)
(443) 449-1862
Entity
Organization
Contact information
Practice address
802 WALNUT GROVE RD, ESSEX, MD 21221-6087
(443) 449-1862
Mailing address
802 WALNUT GROVE RD, ESSEX, MD 21221-6087
(443) 449-1862
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/10/2024
Last updated
08/10/2024
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