=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942824750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARISE & SHINE HEALTH CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2020
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7452 BALTIMORE ANNAPOLIS BLVD STE 200-202
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-209-7100
-----------------------------------------------------
Fax | 443-557-0810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7452 BALTIMORE ANNAPOLIS BLVD STE 200-202
-----------------------------------------------------
City | GLEN BURNIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21061-3547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-209-7100
-----------------------------------------------------
Fax | 443-557-0810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | VIVIAN TANTOH
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 443-466-1476
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------