NPIMap

Organization Active NPI

Baltimore Community Resource Center, Inc

  • Substance Abuse Rehabilitation Facility
  • Baltimore, MD
National Provider Identifier
1558620708
Registry record updated May 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
903995 Issued in MD
Legal business name
BALTIMORE COMMUNITY RESOURCE CENTER, INC
Practice address
3623 Parkdale Ave
Baltimore, MD 21211-1326
Phone
(410) 366-1717
Fax
(410) 889-4167
NPI assigned
May 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2012

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

Authorized official

Name
Robin Woodell
Title
Director
Phone
(410) 366-1717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 903995 MD Primary

Addresses

Primary practice location

3623 Parkdale Ave
Baltimore, MD 21211-1326

Mailing address

21 W 25TH St
Baltimore, MD 21218-5003
Phone (410) 366-1717

Other identifiers 1

IdentifierTypeStateIssuer
417128400MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Baltimore Community Resource Center Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336521600000",
    "number": "1558620708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 W 25TH ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212185003",
            "telephone_number": "410-366-1717",
            "fax_number": "410-889-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 PARKDALE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212111326",
            "telephone_number": "410-366-1717",
            "fax_number": "410-889-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALTIMORE COMMUNITY RESOURCE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-09",
        "last_updated": "2012-05-09",
        "status": "A",
        "authorized_official_last_name": "WOODELL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "410-366-1717"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MD",
            "license": "903995",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "417128400",
            "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 9, 2012; 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.