Organization
MAN ALIVE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORRAINE HELLEN PETERSON (QI AND BILLING)
(443) 310-5494
Entity
Organization
Contact information
Practice address
2117 MARYLAND AVE, BALTIMORE, MD 21218-5614
(410) 837-4292
Mailing address
2117 MARYLAND AVE, BALTIMORE, MD 21218-5614
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
06/28/2022
Last updated
06/28/2022
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