Organization
POWELL RECOVERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM KRANTZ WIREMAN LCSW-C, LGADC (PRESIDENT/CEO)
(410) 276-1773
Entity
Organization
Contact information
Practice address
16 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
Mailing address
14 S BROADWAY, BALTIMORE, MD 21231-1712
(410) 276-1773
(410) 276-2056
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
103079
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218121500
—
MD
05
—
415783400
—
MD
Enumeration date
11/09/2005
Last updated
10/08/2021
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