Provider Demographics
NPI:1801427687
Name:POLARIS DETOX LLC
Entity type:Organization
Organization Name:POLARIS DETOX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-773-0500
Mailing Address - Street 1:8600 LASALLE RD.
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-773-0500
Mailing Address - Fax:410-773-0499
Practice Address - Street 1:7007 YORK RD
Practice Address - Street 2:
Practice Address - City:ABBOTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17301-9774
Practice Address - Country:US
Practice Address - Phone:410-773-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility