Healthcare Provider Details

I. General information

NPI: 1588095087
Provider Name (Legal Business Name): JR HEALTHCARE ASSOCIATES DBA BALTIMORE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 W. PRATT ST.
BALTIMORE MD
21223
US

IV. Provider business mailing address

1101 W. PRATT ST.
BALTIMORE MD
21223
US

V. Phone/Fax

Practice location:
  • Phone: 410-962-7180
  • Fax: 443-874-7061
Mailing address:
  • Phone: 410-962-7180
  • Fax: 443-874-7061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number905062
License Number StateMD

VIII. Authorized Official

Name: MR. TERRY T BROWN
Title or Position: CEO
Credential:
Phone: 410-962-7180