Healthcare Provider Details

I. General information

NPI: 1114718764
Provider Name (Legal Business Name): YESHUA RESTORATION AND HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 POWDERSBY RD
JOPPA MD
21085-5418
US

IV. Provider business mailing address

210 POWDERSBY RD
JOPPA MD
21085-5418
US

V. Phone/Fax

Practice location:
  • Phone: 443-447-2378
  • Fax:
Mailing address:
  • Phone: 443-447-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ROLANDE MEUMELIEU
Title or Position: PRESIDENT
Credential:
Phone: 443-447-2378