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General NPI Number Information
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NPI Number | 1073292330
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Entity Type | Organization
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Legal Business Name | HIS KEEP SAKE, INC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 6340 SECURITY BLVD STE 100, A3, A15, A17, A45, A46
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City | BALTIMORE
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State | MD
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Zip | 21207-5284
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Country | US
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Telephone | 443-473-5080
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Fax |
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Provider Business Mailing Address
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Address Line | 205 ERIN WAY APT 103
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3469
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Country | US
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Telephone | 443-473-5080
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFANY MINTS
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Credential | M.S.
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Telephone | 443-473-5080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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