Active NPI
Stacey Michelle Landrie
- Substance Abuse Rehabilitation Facility
- Cambridge, MD
National Provider Identifier
1972081842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Substance Abuse Rehabilitation Facility
- Practice address
- 828 Airpax Rd Ste 300
Cambridge, MD 21613-6401 - Phone
- (410) 901-1333
- NPI assigned
- Aug 2, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Substance Abuse Rehabilitation Facility | 324500000X | Primary |
Addresses
Primary practice location
828 Airpax Rd Ste 300
Cambridge, MD 21613-6401
Mailing address
828 Airpax Rd Ste 300
Cambridge, MD 21613-6401
Phone (410) 901-1333
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770906901 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533168000000",
"number": "1972081842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 AIRPAX RD STE 300",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216136401",
"telephone_number": "410-901-1333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 AIRPAX RD STE 300",
"city": "CAMBRIDGE",
"state": "MD",
"postal_code": "216136401",
"telephone_number": "410-901-1333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDRIE",
"first_name": "STACEY",
"middle_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-02",
"last_updated": "2018-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "324500000X",
"taxonomy_group": "",
"desc": "Substance Abuse Rehabilitation Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1770906901",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.