Provider Demographics
NPI:1982237491
Name:CITYWIDE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CITYWIDE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-274-8388
Mailing Address - Street 1:17 WARREN RD STE 20B
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5334
Mailing Address - Country:US
Mailing Address - Phone:410-274-8388
Mailing Address - Fax:410-484-8107
Practice Address - Street 1:17 WARREN RD STE 20B
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5334
Practice Address - Country:US
Practice Address - Phone:410-274-8388
Practice Address - Fax:410-484-8107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITYWIDE BEHAVIORAL HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-13
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness