Collington Square Non Profit Corporation

Primary specialty

Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X

License

101466 Issued in MD

Legal business name

COLLINGTON SQUARE NON PROFIT CORPORATION

Doing business as

Bernice E. Meade House of Safe Haven

Practice address

1211 N Chester St
Baltimore, MD 21213-3330

Phone

(410) 342-6858

NPI assigned

Jun 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jewel Gray, ED.D

Title

Executive Director

Phone

(410) 342-6858

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Bernice E. Meade House of Safe Haven Doing business as

Locations

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1124223979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 N CHESTER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212133330",
            "telephone_number": "410-342-6858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 N CHESTER ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212133330",
            "telephone_number": "410-342-6858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINGTON SQUARE NON PROFIT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "JEWEL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-342-6858",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "ED.D"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": "MD",
            "license": "101466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAMIS NO",
            "identifier": "101466",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bernice E. Meade House of Safe Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Beth D Colley, L.C.S.W.
• Sarah Catherine Collica
• Katherine Grant Collier, D.D.S.
• Najae Christian Collier
• Morgan Elizabeth Colling
• Amy Collins
• Beverly Ann Collins, MD, MBA, MS
• Brandy Collins
• Brendan Joseph Collins, M.D.
• Carrie Locken Collins, CPNP-PC

• Children's Substance Abuse Rehabilitation Facility in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Children's Substance Abuse Rehabilitation Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.