Healthcare Provider Details

I. General information

NPI: 1215548573
Provider Name (Legal Business Name): PEACEFUL MINDS RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 S HANOVER ST UNIT 2A2B
BALTIMORE MD
21225-1773
US

IV. Provider business mailing address

3704 S HANOVER ST
BALTIMORE MD
21225-1773
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-7064
  • Fax:
Mailing address:
  • Phone: 443-759-8601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANEE JEREMI SPENCER
Title or Position: OWNER
Credential: LMSW
Phone: 443-418-7064