Organization
PORT RECOVERY IOP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNE GRANRUTH (OWNER)
(410) 534-8735
Entity
Organization
Contact information
Practice address
7000 HARFORD RD, BALTIMORE, MD 21234-7704
(443) 869-4909
(443) 869-4928
Mailing address
8615 RIDGELYS CHOICE DR STE 205, NOTTINGHAM, MD 21236-3028
(410) 534-8735
(410) 534-8737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
680402100
—
MD
Enumeration date
06/08/2012
Last updated
04/14/2019
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