Healthcare Provider Details

I. General information

NPI: 1861328957
Provider Name (Legal Business Name): RISE AND RENEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MARX AVE
BALTIMORE MD
21206-5546
US

IV. Provider business mailing address

4101 MARX AVE
BALTIMORE MD
21206-5546
US

V. Phone/Fax

Practice location:
  • Phone: 443-720-9939
  • Fax:
Mailing address:
  • Phone: 443-720-9939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ANN HINTON
Title or Position: CEO
Credential: CSC-AD
Phone: 443-720-9939