Healthcare Provider Details

I. General information

NPI: 1144194903
Provider Name (Legal Business Name): ANNETTE'S TRANSITION HOUSE CROP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 PENROSE AVE
BALTIMORE MD
21223-1653
US

IV. Provider business mailing address

8926 BALTIMORE ST UNIT 115
SAVAGE MD
20763-7504
US

V. Phone/Fax

Practice location:
  • Phone: 443-473-2350
  • Fax:
Mailing address:
  • Phone: 443-473-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
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: NAKEETA DAVIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-473-2350