Healthcare Provider Details

I. General information

NPI: 1295671204
Provider Name (Legal Business Name): MRS RENEE ASSOCIATION FOUNDATION MRAF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SOLLERS POINT RD
DUNDALK MD
21222-6169
US

IV. Provider business mailing address

419 MAIN STREET
DUNDALK MD
21222-6243
US

V. Phone/Fax

Practice location:
  • Phone: 443-345-0344
  • Fax:
Mailing address:
  • Phone: 443-345-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTUAN SCOTT
Title or Position: CHIEF COMPLIANCE OFFICER / CCO
Credential:
Phone: 443-345-0344