Organization Active NPI

Glenwood Life-Counseling Center Inc

  • Methadone Clinic
  • Baltimore, MD
National Provider Identifier
1104802420
Registry record updated Dec 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
GLENWOOD LIFE-COUNSELING CENTER INC
Practice address
516 Glenwood Ave
Baltimore, MD 21212-4230
Phone
(410) 323-9811
Fax
(410) 323-3862
NPI assigned
Dec 19, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Authorized official

Name
Aredenia Langley
Title
Billing Supervisor
Phone
(410) 323-9811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

516 Glenwood Ave
Baltimore, MD 21212-4230

Mailing address

516 Glenwood Ave
Baltimore, MD 21212-4230
Phone (410) 323-9811

Other identifiers 1

IdentifierTypeStateIssuer
750251600MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Opioid treatment program
Medicare-enrolled since Feb 17, 2026

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200319000318 MD Part B Supplier - Opioid Treatment Program (Otp) 1658602974 Practice locations: Baltimore, MD

National Provider Directory

National Provider Directory

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": "1134950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1104802420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 GLENWOOD AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212124230",
            "telephone_number": "410-323-9811",
            "fax_number": "410-323-3862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 GLENWOOD AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212124230",
            "telephone_number": "410-323-9811",
            "fax_number": "410-323-3862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENWOOD LIFE-COUNSELING CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-19",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "LANGLEY",
        "authorized_official_first_name": "AREDENIA",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "410-323-9811"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "750251600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "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 Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.