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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 322D00000X | Residential Treatment Facility, Emotionally Disturbed Children | 03-049 | MD | Residential Treatment Facilities |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MD | 427825900 | 05 |
Street Address |
4100 MAPLE AVENUE |
City | BALTIMORE |
State | MD |
Zip Code | 21227-4007 |
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 |
Find all providers in zip 21227 |
Taxonomy Code | 322D00000X |
Grouping | Residential Treatment Facilities |
Classification | Residential Treatment Facility, Emotionally Disturbed Children |
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. |
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 |
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 |
Find all providers with the same taxonomy |
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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.