Healthcare Provider Details

I. General information

NPI: 1467316182
Provider Name (Legal Business Name): HEALTHY LIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 DIVISION ST
BALTIMORE MD
21217-3002
US

IV. Provider business mailing address

1001 PINE HEIGHTS AVE STE 303
BALTIMORE MD
21229-5202
US

V. Phone/Fax

Practice location:
  • Phone: 443-219-7901
  • Fax:
Mailing address:
  • Phone: 443-219-7901
  • 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 State

VIII. Authorized Official

Name: AHMEIN WATSON
Title or Position: CEO
Credential:
Phone: 443-722-3116