Organization
FOR 4EVERBLESSED LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEYANNA D WILLIAMS (BILLING COORDINATOR)
(443) 392-6934
Entity
Organization
Contact information
Practice address
3605 COURTLEIGH DR, RANDALLSTOWN, MD 21133-4806
(443) 392-6934
Mailing address
8747 FONTANA LN, BALTIMORE, MD 21237-2300
(443) 392-6934
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
311ZA0620X
Adult Care Home Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
07/06/2023
Last updated
07/06/2023
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