=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154109304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH EMPOWERMENT NETWORK OF MARYLAND, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 68TH PLACE
-----------------------------------------------------
City | SEAT PLEASANT
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20743
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-435-5038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12138 CENTRAL AVENUE, SUITE 112
-----------------------------------------------------
City | MITCHVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20621-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-435-5038
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. EUGENE W. GRANT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-435-5038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------