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Wanda Pulliam
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Baltimore, Maryland
NPI 1609523885

Wanda Pulliam is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Baltimore, MD. Wanda Pulliam practices in Baltimore, MD. The NPI Number for Wanda Pulliam is 1609523885 and holds a License No. (Maryland).

The current practice location address for Wanda Pulliam is 843 N Augusta Ave, Baltimore, MD and can be reached out via phone at 443-829-4562.

Location: 843 N Augusta Ave, Baltimore, MD, 21229-1823
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609523885
Provider Name
Wanda Pulliam
Credential
Provider Entity Type
Individual
Gender
Female
Address
843 N Augusta Ave, Baltimore, MD, 21229-1823
Phone Number
443-829-4562
Fax Number
Provider Enumeration Date
03/07/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
843 N Augusta Ave
City
Baltimore
State
Maryland
Zip
21229-1823
Phone Number
443-829-4562
Fax Number
person
Provider Business Mailing Address Details
Address
843 N Augusta Ave
City
Baltimore
State
Maryland
Zip
21229-1823
Phone Number
443-829-4562
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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