Healthcare Provider Details

I. General information

NPI: 1003293218
Provider Name (Legal Business Name): JOHNNY CARES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 GREENMOUNT AVE
BALTIMORE MD
21218-3938
US

IV. Provider business mailing address

1734 MARYLAND AVE
BALTIMORE MD
21201-5804
US

V. Phone/Fax

Practice location:
  • Phone: 410-467-6040
  • Fax: 410-467-5944
Mailing address:
  • Phone: 410-467-6040
  • Fax: 410-467-5944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM GREEN
Title or Position: CEO
Credential:
Phone: 410-467-6040