Healthcare Provider Details

I. General information

NPI: 1902541113
Provider Name (Legal Business Name): WAY OF HOPE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 W NORTH AVE
BALTIMORE MD
21216-3018
US

IV. Provider business mailing address

7412 RICKSWAY RD
BALTIMORE MD
21208-5719
US

V. Phone/Fax

Practice location:
  • Phone: 443-623-2449
  • Fax:
Mailing address:
  • Phone: 443-794-9094
  • Fax: 410-486-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE G FERNELIS
Title or Position: CEO/OWNER
Credential:
Phone: 443-794-9094