NPIMap

Organization Active NPI

Citywide Behavioral Health

Doing business as Citywide 3.11 - Residential Program

  • Mental Illness Community Based Residential Treatment Facility
  • Baltimore, MD
National Provider Identifier
1982237491
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CITYWIDE BEHAVIORAL HEALTH
Doing business as
Citywide 3.11 - Residential Program
Practice address
17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone
(410) 274-8388
Fax
(410) 484-8107
NPI assigned
Feb 13, 2020
Organization subpart
Yes
Parent organization
CITYWIDE BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Authorized official

Name
Pamela P Johnson, CRNPNPI 1023252129
Title
Medical Director
Phone
(410) 274-8388

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334

Mailing address

17 Warren Rd Ste 20B
Baltimore, MD 21208-5334
Phone (410) 274-8388

Other names 2

  • Citywide 3.11 - Residential Program Doing business as
  • CITYWIDE BEHAVIORAL HEALTH Other name

National Provider Directory

National Provider Directory
Tax ID family
Citywide Behavioral Health11 organizations share this tax ID, including this one
Part of
Citywide Behavioral Health

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1982237491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-274-8388",
            "fax_number": "410-484-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WARREN RD STE 20B",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212085334",
            "telephone_number": "410-274-8388",
            "fax_number": "410-484-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITYWIDE BEHAVIORAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CITYWIDE BEHAVIORAL HEALTH",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "410-274-8388",
        "authorized_official_credential": "CRNP"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Citywide 3.11 - Residential Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CITYWIDE BEHAVIORAL HEALTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Feb 13, 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.