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Organization

WOODBOURNE SCHOOL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ANTHONY WILSON (EXECUTIVE DIRECTOR)
(410) 433-1000
Entity
Organization

Contact information

Practice address
1301 WOODBOURNE AVE, BALTIMORE, MD 21239-3316
(410) 433-1000
(410) 433-1459
Mailing address
1301 WOODBOURNE AVE, BALTIMORE, MD 21239-3316
(410) 433-1000
(410) 433-1459

Taxonomy

Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
3875
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
235395400
MD
Enumeration date
06/16/2016
Last updated
06/16/2016
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