NPIMap

Organization Active NPI

Issiaih House 1

  • Clinic/Center
  • Glen Burnie, MD
National Provider Identifier
1568096428
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ISSIAIH HOUSE 1
Practice address
2301 Dorsey Rd
Glen Burnie, MD 21061-3299
Phone
(443) 882-1943
NPI assigned
Feb 28, 2020
Organization subpart
Yes
Parent organization
ISSAIAH HOUSE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Authorized official

Name
Mr. Darryl Braxton, LCPC, LCADC
Title
Owner
Phone
(443) 882-1943

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2301 Dorsey Rd
Glen Burnie, MD 21061-3299

Mailing address

4313 Briggs Chaney Rd
Beltsville, MD 20705-1044
Phone (443) 882-1943

Other names 1

  • Issaiah House 1 Inc Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Issaiah House 1 Inc3 organizations share this tax ID, including this one
Part of
Issaiah House Inc

Other organizations with this tax ID 2

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

Locations

2301 Dorsey Rd
Glen Burnie, MD 21061
Phone (443) 882-1943

NPI Registry JSON

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

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1568096428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4313 BRIGGS CHANEY RD",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207051044",
            "telephone_number": "443-882-1943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 DORSEY RD",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210613299",
            "telephone_number": "443-882-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSIAIH HOUSE 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ISSAIAH HOUSE INC",
        "enumeration_date": "2020-02-28",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "BRAXTON",
        "authorized_official_first_name": "DARRYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-882-1943",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC, LCADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Issaiah House 1 Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.