Healthcare Provider Details

I. General information

NPI: 1295648459
Provider Name (Legal Business Name): NENNY COMMUNITY SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S PULASKI ST
BALTIMORE MD
21223-2924
US

IV. Provider business mailing address

319 S PULASKI ST
BALTIMORE MD
21223-2924
US

V. Phone/Fax

Practice location:
  • Phone: 443-679-2212
  • Fax:
Mailing address:
  • Phone: 443-679-2212
  • 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

VIII. Authorized Official

Name: MS. NNENNA DORATHY EZEH
Title or Position: FOUNDER/CEO
Credential: MSW, BSW, CSC-AD,
Phone: 443-679-2212