Organization
TRANSFORMATION STATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARRYL MOODY (OWNER)
(443) 310-2572
Entity
Organization
Contact information
Practice address
4200 EDMONDSON AVE STE 100, BALTIMORE, MD 21229-1617
(443) 310-2572
Mailing address
4200 EDMONDSON AVE STE 100, BALTIMORE, MD 21229-1617
(443) 310-2572
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
215JT87C
—
MD
Enumeration date
07/21/2022
Last updated
08/18/2023
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