Healthcare Provider Details

I. General information

NPI: 1649106642
Provider Name (Legal Business Name): JERI HOPEFUL HAVEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2031
WALDORF MD
20602-3313
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE SCO1075
WALDORF MD
20602-3223
US

V. Phone/Fax

Practice location:
  • Phone: 240-463-6759
  • Fax:
Mailing address:
  • Phone: 240-463-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANNE N ALLEN
Title or Position: OWNER
Credential: PMHNP
Phone: 240-463-6759