Healthcare Provider Details

I. General information

NPI: 1992144505
Provider Name (Legal Business Name): NEWBORN HOLISTIC MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 PENNSYLVANIA AVE
BALTIMORE MD
21217-3232
US

IV. Provider business mailing address

1947 PENNSYLVANIA AVE P.O. BOX 12764
BALTIMORE MD
21217-5764
US

V. Phone/Fax

Practice location:
  • Phone: 410-728-8402
  • Fax: 410-728-8424
Mailing address:
  • Phone: 410-728-8402
  • Fax: 410-728-8424

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
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD MARCUS
Title or Position: PRESIDENT
Credential:
Phone: 410-728-2227