Provider Demographics
NPI:1669953394
Name:FIRST LIGHT RECOVERY PROGRAM INC
Entity type:Organization
Organization Name:FIRST LIGHT RECOVERY PROGRAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILL
Authorized Official - Suffix:SR
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:240-343-2709
Mailing Address - Street 1:1401 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3135
Mailing Address - Country:US
Mailing Address - Phone:240-343-2709
Mailing Address - Fax:
Practice Address - Street 1:1401 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3135
Practice Address - Country:US
Practice Address - Phone:240-343-2709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty