Healthcare Provider Details

I. General information

NPI: 1679068787
Provider Name (Legal Business Name): A MOTHER'S TOUCH SUPPORTIVE HOUSING & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2018
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 ANNABEL AVE
BALTIMORE MD
21225-1913
US

IV. Provider business mailing address

614 ANNABEL AVE
BALTIMORE MD
21225-1913
US

V. Phone/Fax

Practice location:
  • Phone: 443-546-8253
  • Fax:
Mailing address:
  • Phone: 443-546-8253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAKEETA BRANCH
Title or Position: COO
Credential:
Phone: 443-546-8253