Healthcare Provider Details

I. General information

NPI: 1285498501
Provider Name (Legal Business Name): HOPE RISING MENTAL HELTH AND SUBSTANCE ABUSE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 SAINT HELENA AVE
BALTIMORE MD
21222-4010
US

IV. Provider business mailing address

6565 SAINT HELENA AVE
BALTIMORE MD
21222-4010
US

V. Phone/Fax

Practice location:
  • Phone: 410-501-9796
  • Fax:
Mailing address:
  • Phone: 410-501-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JEVON ANDRE PATRICK
Title or Position: OWNER/CEO
Credential:
Phone: 410-501-9796