Healthcare Provider Details

I. General information

NPI: 1376480558
Provider Name (Legal Business Name): DONNAS RECOVERY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 N CARROLLTON AVE APT 1
BALTIMORE MD
21217-3259
US

IV. Provider business mailing address

619 N CARROLLTON AVE APT 1
BALTIMORE MD
21217-3259
US

V. Phone/Fax

Practice location:
  • Phone: 443-744-5368
  • Fax: 443-744-5368
Mailing address:
  • Phone: 443-744-5368
  • Fax: 443-744-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: IRISHA LUCAS
Title or Position: OWNER
Credential:
Phone: 443-744-5368