Healthcare Provider Details

I. General information

NPI: 1801573274
Provider Name (Legal Business Name): HOPE-FULLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BELAIR RD UNIT A
BALTIMORE MD
21206-1839
US

IV. Provider business mailing address

6413 TOTTERIDGE ST
MIDDLE RIVER MD
21220-3092
US

V. Phone/Fax

Practice location:
  • Phone: 410-983-1117
  • Fax:
Mailing address:
  • Phone: 443-449-4191
  • 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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JADE JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 443-449-4191