Healthcare Provider Details
I. General information
NPI: 1831823574
Provider Name (Legal Business Name): MORELIFE SOLUTIONS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/09/2022
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5335 REISTERSTOWN RD
BALTIMORE MD
21215-4401
US
IV. Provider business mailing address
626 OTTER CREEK RD
EDGEWOOD MD
21040-3604
US
V. Phone/Fax
- Phone: 667-201-3790
- Fax:
- Phone: 667-201-3790
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QM0801X |
| Taxonomy | Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MINA
CADE
Title or Position: OWNER
Credential: CRNP
Phone: 410-615-3385