Organization
SUCCESS STARTS HERE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONE C DUBOSE II (CEO)
(443) 858-1997
Entity
Organization
Contact information
Practice address
112 E 25TH ST UNIT 1, BALTIMORE, MD 21218-5214
(443) 858-1997
Mailing address
5714 ALLENDER RD, WHITE MARSH, MD 21162-1307
(443) 858-1997
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
02/19/2022
Last updated
09/29/2022
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