Organization
JOPPA HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT GARRETT BOWMAN CAC-AD (ADMINISTRATIVE DIRECTOR)
(410) 259-4985
Entity
Organization
Contact information
Practice address
623 PULASKI HWY # A, JOPPA, MD 21085-3914
(410) 538-5809
(410) 538-4249
Mailing address
623 PULASKI HWY # A, JOPPA, MD 21085-3914
(410) 538-5809
(410) 538-4249
Taxonomy
Speciality
Code
Description
License number
State
261QM2800X
Methadone Clinic
Primary
11026
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026500400
—
MD
01
—
MD10077M
FDA ID NUMBER
MD
Enumeration date
01/10/2007
Last updated
10/24/2011
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