=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871434035
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.A BURRELL ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2026
-----------------------------------------------------
Last Update Date | 04/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2308 WHITTIER AVE APT B
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21217-5280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-814-8956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 E NORTH AVE STE 5
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-4886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-814-8956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROGRAM DIRECTOR
-----------------------------------------------------
Name | RASHEEAH AMEERAH BURRELL
-----------------------------------------------------
Credential | BURRELL
-----------------------------------------------------
Telephone | 410-814-8956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------