Provider Demographics
NPI:1366095887
Name:LHC HOUSE OF REFUGE
Entity type:Organization
Organization Name:LHC HOUSE OF REFUGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MADC ADT
Authorized Official - Phone:443-473-6804
Mailing Address - Street 1:4300 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4812
Mailing Address - Country:US
Mailing Address - Phone:410-807-1250
Mailing Address - Fax:
Practice Address - Street 1:4300 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4812
Practice Address - Country:US
Practice Address - Phone:410-807-1250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REFUGE PROPERTY INVESTMENTS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty