Healthcare Provider Details

I. General information

NPI: 1689042541
Provider Name (Legal Business Name): JR HEALTH CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 N CHARLES ST
BALTIMORE MD
21218-5127
US

IV. Provider business mailing address

2310 N CHARLES ST
BALTIMORE MD
21218-5127
US

V. Phone/Fax

Practice location:
  • Phone: 410-844-4110
  • Fax:
Mailing address:
  • Phone: 410-844-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number905861
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number905861
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMH-1846
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH-1846
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMH-1846
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMH-1962
License Number StateMD
# 7
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberMH-1962
License Number StateMD
# 8
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number905861
License Number StateMD

VIII. Authorized Official

Name: NAG NELLURI
Title or Position: PRESIDENT
Credential:
Phone: 443-995-4113