Powell Recovery Center, Inc.

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

21771 Issued in MD

Legal business name

POWELL RECOVERY CENTER, INC.

Practice address

14 S Broadway
Baltimore, MD 21231-1712

Phone

(410) 276-1773

Fax

(410) 276-2056

NPI assigned

Oct 30, 2008

Last updated

Aug 12, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kim Wireman, LCSW-CNPI 1437304862

Title

President/Ceo

Phone

(443) 610-1455

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Powell Recovery Center, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
  • NPI 1952382665

  O20070910000225

  Same enrollment

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kim K Wireman, LCSW-C, LCADC

  • Clinical Social Worker
  • Baltimore, MD
  • NPI 1437304862
  Authorized official Same address or phone
• Joey Lynn Wallace

  • Mental Health Counselor
  • Baltimore, MD
  • NPI 1255977138
  NPD

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1699928994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 S BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311712",
            "telephone_number": "410-276-1773",
            "fax_number": "410-276-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 S BROADWAY",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212311712",
            "telephone_number": "410-276-1773",
            "fax_number": "410-276-2056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWELL RECOVERY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-30",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "WIREMAN",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "443-610-1455",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "MD",
            "license": "21771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218121500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.
• Powell Recovery Center, Inc.

• Adult Mental Health Clinic/Center in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Adult Mental Health Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.