Healthcare Provider Details

I. General information

NPI: 1578246138
Provider Name (Legal Business Name): HEALTHY MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 09/06/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 PHILADELPHIA RD STE 106
ROSEDALE MD
21237-4346
US

IV. Provider business mailing address

9114 PHILADELPHIA RD STE 106
ROSEDALE MD
21237-4346
US

V. Phone/Fax

Practice location:
  • Phone: 240-443-8255
  • Fax:
Mailing address:
  • Phone: 240-443-8255
  • 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: JACQUETTE JACOBS
Title or Position: CEO
Credential:
Phone: 240-468-8476