Healthcare Provider Details

I. General information

NPI: 1548011604
Provider Name (Legal Business Name): URBAN VITALITY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W LOMBARD ST STE 1053
BALTIMORE MD
21223-3134
US

IV. Provider business mailing address

7201 ALDEN WAY UNIT 2018
HANOVER MD
21076-2478
US

V. Phone/Fax

Practice location:
  • Phone: 443-904-8336
  • Fax:
Mailing address:
  • Phone: 443-904-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TACARIA GARDNER
Title or Position: CO OWNER
Credential:
Phone: 443-904-8336