Healthcare Provider Details

I. General information

NPI: 1891511861
Provider Name (Legal Business Name): HOPE HAVEN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S BAYLIS ST
BALTIMORE MD
21224-5206
US

IV. Provider business mailing address

9602 MAXWELL RD
MIDDLE RIVER MD
21220-3792
US

V. Phone/Fax

Practice location:
  • Phone: 443-290-7997
  • Fax:
Mailing address:
  • Phone: 443-616-6802
  • 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 Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. OLUWATOYIN OMONIYI OLALEYE
Title or Position: OWNER
Credential: NP
Phone: 443-616-6802