Healthcare Provider Details

I. General information

NPI: 1043199102
Provider Name (Legal Business Name): HOPE-FULLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BELAIR RD
BALTIMORE MD
21206-1839
US

IV. Provider business mailing address

6301 BELAIR RD
BALTIMORE MD
21206-1839
US

V. Phone/Fax

Practice location:
  • Phone: 443-835-4353
  • Fax:
Mailing address:
  • Phone: 443-835-4353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

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