NPIMap

Organization Active NPI

Gemini Treatment Center, LLC

  • Clinic/Center
  • Baltimore, MD
National Provider Identifier
1023737012
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GEMINI TREATMENT CENTER, LLC
Practice address
705 E Patapsco Ave Ste a
Baltimore, MD 21225-1934
Phone
(410) 891-6677
NPI assigned
Aug 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kevin M Johnson Sr.NPI 1285221333
Title
Ceo
Phone
(443) 202-1685

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

705 E Patapsco Ave Ste a
Baltimore, MD 21225-1934

Mailing address

705 E Patapsco Ave Ste a
Baltimore, MD 21225-1934
Phone (410) 891-6677

Other identifiers 1

IdentifierTypeStateIssuer
NAMedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kjohnsonsr@reallifechanges.org

National Provider Directory

National Provider Directory
Tax ID family
Gemini Treatment Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

705 E Patapsco Ave
Ste A
Baltimore, MD 21225
Phone (410) 891-6677

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1023737012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 E PATAPSCO AVE STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251934",
            "telephone_number": "410-891-6677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 E PATAPSCO AVE STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251934",
            "telephone_number": "410-891-6677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEMINI TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-202-1685",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NA",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kjohnsonsr@reallifechanges.org",
            "affiliation": "N",
            "address_1": "705 E Patapsco Ave Ste A",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212251934",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.