Organization
BLONNIE'S HOUSE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CLARICE VERONICA VANBRAKLE (CEO)
(410) 929-5423
Entity
Organization
Contact information
Practice address
4000 ERDMAN AVE, BALTIMORE, MD 21213-2006
(410) 929-5423
Mailing address
12138 CENTRAL AVE # 504, MITCHELLVILLE, MD 20721-1910
(410) 929-5423
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
05/02/2020
Last updated
07/28/2020
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