Healthcare Provider Details

I. General information

NPI: 1659071454
Provider Name (Legal Business Name): HYGEA HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6415 BELAIR RD STE B
BALTIMORE MD
21206-1841
US

IV. Provider business mailing address

400 REDLAND CT STE 102
OWINGS MILLS MD
21117-3291
US

V. Phone/Fax

Practice location:
  • Phone: 410-559-1800
  • Fax:
Mailing address:
  • Phone: 410-559-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JORDANA BLESA
Title or Position: PRESIDENT
Credential: MBA, BSBM, CADCII
Phone: 626-375-3309