THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE


Address: 4100 Maple Avenue, Baltimore, MD 21227-4007
Phone: 4102472770

THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE (NPI# 1508980251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1508980251
Entity Type Organization
Organization Name THE HOUSE OF THE GOOD SHEPHERD OF THE CITY OF BALTIMORE
Practice Address 4100 Maple Avenue
Baltimore
MD 21227-4007
Practice Telephone 4102472770
Practice Fax Number 4102473242
Mailing Telephone 4102472770
Mailing Fax Number 4102473242
Enumeration Date 2007-03-19
Last Update Date 2009-05-13
Authorized Official Name DERRICK A. BOONE (PRESIDENT & CEO)
Authorized Official Telephone 4102472770
Authorized Official Credential PSY.D.
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 322D00000X Residential Treatment Facility, Emotionally Disturbed Children 03-049 MD Residential Treatment Facilities

Other Provider Identifier

State Issuer Identifier Type Code
MD 427825900 05

Office Location

Street Address 4100 MAPLE AVENUE
City BALTIMORE
State MD
Zip Code 21227-4007

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1528622024 Kim Conaway Counselor Regenerations Counseling Services, 1421 S. Canton Street, Baltimore, MD 21227 2019-04-30
1861974891 Joan Lynn Indilisano Occupational Therapist 3320 Benson Avenue, Baltimore, MD 21227 2018-09-06
1821593161 Institute for Dermatopathology, Inc. Clinical Medical Laboratory 1901 Sulphur Spring Rd Ste A, Baltimore, MD 21227 2018-03-28
1447779699 Aja Williams Registered Nurse 3902 Annapolis Rd., Halethorpe, MD 21227 2017-09-19
1588190748 Mentor-maryland Community/Behavioral Health 1540 Caton Center Drive, Halethorpe, MD 21227 2017-05-10
1083084180 Institute for Family Centered Services Community/Behavioral Health 1540 Caton Centered Drive, Suite F, Baltimore, MD 21227 2015-10-01
1174913677 Wye Oak Clinic, Inc. Marriage & Family Therapist 1937 Lansdowne Rd, Halethorpe, MD 21227 2015-02-04
1588938237 Ahmein Watson Social Worker 1504 Joh Ave Ste 120, Baltimore, MD 21227 2012-02-28
1336442656 Norah Orise Osian Pharmacist Rite Aid Pharmacy, 1400 Sulphur Spring Rd, Baltimore, MD 21227 2010-12-08
1366759623 Een J Lee Pharmacist 1400 Sulphurspring Rd, Baltimore, MD 21227 2010-09-08
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Taxonomy Information

Taxonomy Code 322D00000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Emotionally Disturbed Children

Taxonomy Definition

A provider facility or distinct part of the organization which renders an interdisciplinary program of mental health treatment to individuals under 21 years of age who have persistent dysfunction in major life areas. The dysfunction is of an extent and pervasiveness that requires a protected and highly structured therapeutic environment. These organizations, or distinct part of organizations, exclude those that provide acute psychiatric care, partial hospitalization, group living, therapeutic schooling, primary diagnosis substance abuse disorder treatment, or primary diagnosis mental retardation or developmental disability treatment.
Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1063402121 Rica-baltimore Residential Treatment Facility, Emotionally Disturbed Children 605 S Chapel Gate Ln, Baltimore, MD 21229-3906 2005-10-28
1275614968 Mann Rtc Residential Treatment Facility, Emotionally Disturbed Children 6501 N Charles St, Baltimore, MD 21204-6819 2006-10-18

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1326219486 North American Family Institute Residential Treatment Facility, Emotionally Disturbed Children 7960 Henryton Rd, Marriottsville, MD 21104-1103 2008-03-17
1851480065 Three Springs, Inc. Residential Treatment Facility, Emotionally Disturbed Children 20700 Wagoner Cutoff Road, Oldtown, MD 21555 2006-10-12
1255424164 Sheppard Pratt Health System, Inc Residential Treatment Facility, Emotionally Disturbed Children 2940 Point of Rocks Rd., Jefferson, MD 21755-0009 2006-10-02
1033149257 The Woodbourne Center, Inc. Residential Treatment Facility, Emotionally Disturbed Children 1220b E Joppa Rd Ste 433, Towson, MD 21286-5819 2006-07-04
1104805696 Regional Institute for Children and Adolescents - Southern Maryland Residential Treatment Facility, Emotionally Disturbed Children 9400 Surratts Rd, Cheltenham, MD 20623-1324 2006-01-12
1033101738 John L. Gildner Regional Institute for Children and Adolescents Residential Treatment Facility, Emotionally Disturbed Children 15000 Broschart Rd, Rockville, MD 20850-3303 2005-08-18
1053445247 Potomac Ridge Behaviorial Health Eastern Shore Residential Treatment Facility, Emotionally Disturbed Children 821 Fieldcrest Rd, Cambridge, MD 21613-9423 2007-03-16
1285765636 Potomac Ridge- Eastern Shore Residential Treatment Facility, Emotionally Disturbed Children 821 Fieldcrest Rd, Cambridge, MD 21613-9423 2007-03-08
1104952050 Potomac Ridge Behavorial Health Eastern Shore Residential Treatment Facility, Emotionally Disturbed Children 821 Fieldcrest Rd, Cambridge, MD 21613-9423 2007-02-26
1700920527 Potomac Ridge Behaviorial Health System Eastern Shore Residential Treatment Facility, Emotionally Disturbed Children 821 Fieldcrest Rd, Cambridge, MD 21613-9423 2007-02-16
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Competitor

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City BALTIMORE
Zip Code 21227

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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