Healthcare Provider Details

I. General information

NPI: 1053208751
Provider Name (Legal Business Name): HEALTH CONCEPTS BEACON HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W PRATT STREET SUITES 102, 103, 303
BALTIMORE MD
21223-2693
US

IV. Provider business mailing address

1101 W PRATT STREET SUITES 102, 103, 303
BALTIMORE MD
21223-2693
US

V. Phone/Fax

Practice location:
  • Phone: 443-466-7500
  • Fax:
Mailing address:
  • Phone: 443-466-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TYNISHA KADIRI
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: PMHNP
Phone: 443-466-7500