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General NPI Number Information
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NPI Number | 1124471651
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Entity Type | Organization
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Legal Business Name | JR HEALTHCARE ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 2310 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5127
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Country | US
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Telephone | 410-844-4110
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Fax | 410-741-3008
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Provider Business Mailing Address
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Address Line | 2310 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21218-5127
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Country | US
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Telephone | 410-844-4110
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Fax | 410-741-3008
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Authorized Official
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Title or Position | MEMBER
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Name | NAG NELLURI
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Credential |
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Telephone | 443-995-4113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MH-1846
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License Number State | MD
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