Provider Demographics
NPI:1487292017
Name:CITYWIDE COMMUNITY RESOURCES CORPORATION
Entity type:Organization
Organization Name:CITYWIDE COMMUNITY RESOURCES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/ CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:410-274-8388
Mailing Address - Street 1:17 WARREN ROAD SUITE 20B, ROOM 7
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-929-2314
Mailing Address - Fax:410-484-8107
Practice Address - Street 1:17 WARREN ROAD SUITE 20B, ROOM 7
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-929-2314
Practice Address - Fax:410-484-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health