NPIMap

Organization Active NPI

Eastern Avenue Health Solutions

  • Methadone Clinic
  • Baltimore, MD
National Provider Identifier
1366821118
Registry record updated May 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
EASTERN AVENUE HEALTH SOLUTIONS
Practice address
5920 Eastern Ave
Baltimore, MD 21224-2730
Phone
(410) 631-2772
NPI assigned
May 27, 2015
Last updated
May 27, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2015

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

Authorized official

Name
Charles Watson, LGSW
Title
Director
Phone
(443) 841-2598

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

5920 Eastern Ave
Baltimore, MD 21224-2730

Mailing address

5920 Eastern Ave
Baltimore, MD 21224-2730
Phone (410) 631-2772

Other identifiers 1

IdentifierTypeStateIssuer
4211715MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Eastern Avenue Health Solutions Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432684800000",
    "number": "1366821118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242730",
            "telephone_number": "410-631-2772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 EASTERN AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212242730",
            "telephone_number": "410-631-2772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN AVENUE HEALTH SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2015-05-27",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-841-2598",
        "authorized_official_credential": "LGSW"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4211715",
            "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 May 27, 2015; 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.