NPIMap

Organization Active NPI

Icwc Recovery Inc

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Baltimore, MD
National Provider Identifier
1922663574
Registry record updated May 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
ICWC RECOVERY INC
Practice address
4413 Park Heights Ave
Baltimore, MD 21215-6323
Phone
(443) 708-3834
NPI assigned
May 8, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2019

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

Authorized official

Name
Tyrica Cason
Title
President/Ceo
Phone
(856) 304-3911

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YA0400X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

4413 Park Heights Ave
Baltimore, MD 21215-6323

Mailing address

4413 Park Heights Ave
Baltimore, MD 21215-6323
Phone (443) 708-3834

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1557273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1922663574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4413 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156323",
            "telephone_number": "443-708-3834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4413 PARK HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212156323",
            "telephone_number": "443-708-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICWC RECOVERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-08",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "CASON",
        "authorized_official_first_name": "TYRICA",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "856-304-3911"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 8, 2019; 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.