Healthcare Provider Details

I. General information

NPI: 1326975715
Provider Name (Legal Business Name): HEAVENS HEARTS HEALING & SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 KESWICK RD
BALTIMORE MD
21211-2634
US

IV. Provider business mailing address

5105 BRIGHT OWL RD
PERRY HALL MD
21128-8971
US

V. Phone/Fax

Practice location:
  • Phone: 443-722-5365
  • Fax:
Mailing address:
  • Phone: 443-722-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KELLY NASH
Title or Position: PRESIDENT
Credential:
Phone: 443-722-5365