Woodbourne School

Primary specialty

Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X

License

3875 Issued in MD

Legal business name

WOODBOURNE SCHOOL

Practice address

1301 Woodbourne Ave
Baltimore, MD 21239-3316

Phone

(410) 433-1000

Fax

(410) 433-1459

NPI assigned

Jun 16, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Anthony Wilson

Title

Executive Director

Phone

(410) 433-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Psychiatric residential treatment facility certification: CCN 21L013

Legal name

NEXUS WOODBOURNE FAMILY HEALING CENTER

Certification status

Active

Provider type (POS)

Psychiatric residential treatment facility

Participating since

Jun 26, 2003

Last certification

Jun 26, 2003

Beds

54

Ownership / control type

For profit – individual

Facility address

1301 Woodbourne Avenue
Baltimore, MD 21239

Tax ID family

Nexus-Woodbourne Family Healing3 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.

• Nexus-Woodbourne Family Healing

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Baltimore, MD
  • NPI 1033149257
  NPD tax ID
• Woodbourne Center

  • School Social Worker
  • Baltimore, MD
  • NPI 1659829398
  NPD tax ID

Locations

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1679923056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 WOODBOURNE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212393316",
            "telephone_number": "410-433-1000",
            "fax_number": "410-433-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 WOODBOURNE AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212393316",
            "telephone_number": "410-433-1000",
            "fax_number": "410-433-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBOURNE SCHOOL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-433-1000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "MD",
            "license": "3875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "235395400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey Yolanda Wood, CNM
• Stephanie Jeanette Wood, LMSW
• Tawnie Wood
• Geronimo Cullen Woodard
• Woodbourne Center
• Scott Edward Woodburn, DPM
• Margaret Woodbury
• Chanel P Wooden
• Matthew Rayner Woodford, MD
• Woodhaven Infusion Services, Inc.

• Psychiatric Residential Treatment Facility in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Psychiatric Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.