Organization Active NPI

East Baltimore Community Corporation / Reflective Treatment Center

  • Addiction (Substance Use Disorder) Counselor
  • Baltimore, MD
National Provider Identifier
1194796615
Registry record updated Mar 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
316811 Issued in MD
Legal business name
EAST BALTIMORE COMMUNITY CORPORATION / REFLECTIVE TREATMENT CENTER
Practice address
301 N Gay St
Baltimore, MD 21202-4831
Phone
(410) 752-3500
Fax
(410) 528-1005
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2015

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

Authorized official

Name
Ms. Muriel V. Brothers
Title
Program Administrator
Phone
(410) 727-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X 316811 MD Primary

Addresses

Primary practice location

301 N Gay St
Baltimore, MD 21202-4831

Mailing address

301 N Gay St
Baltimore, MD 21202-4813
Phone (410) 752-3500

Other identifiers 1

IdentifierTypeStateIssuer
733530000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Opioid treatment program
Medicare-enrolled since Aug 7, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201215001693 MD Part B Supplier - Opioid Treatment Program (Otp) 0345652475 Practice locations: Baltimore, MD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2056504Reflective Treatment Center301 N Gay Street, Baltimore, MD 21202Certificate of waiverMar 27, 2027

National Provider Directory

National Provider Directory

Locations

301 N Gay St
Baltimore, MD 21202
Phone (410) 752-3500

301 N Gay St
Lowr
Baltimore, MD 21202

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": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1194796615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 N GAY ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024813",
            "telephone_number": "410-752-3500",
            "fax_number": "410-528-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N GAY ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212024831",
            "telephone_number": "410-752-3500",
            "fax_number": "410-528-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST BALTIMORE COMMUNITY CORPORATION / REFLECTIVE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "BROTHERS",
        "authorized_official_first_name": "MURIEL",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PROGRAM ADMINISTRATOR",
        "authorized_official_telephone_number": "410-727-7400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MD",
            "license": "316811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "733530000",
            "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 Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.