MEDICARE: PASSIONATE HANDS TRANSITIONAL HOUSING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1073864229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSIONATE HANDS TRANSITIONAL HOUSING

Provider Business Mailing Address
First Line	:	4711 LIBERTY HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-7155
Country	:	US
Telephone Number	:	410-982-2242
Fax Number	:

Provider Business Practice Location Address
First Line	:	4711 LIBERTY HEIGHTS AVE FL 2
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-7155
Country	:	US
Telephone Number	:	410-982-2422
Fax Number	:	410-466-7002

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. YOLANDA A BROWN
Credential	:
Telephone Number	:	410-982-2242

Provider Enumeration Date	:	09/27/2012
Last Update Date	:	11/15/2021

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Directions to “PASSIONATE HANDS TRANSITIONAL HOUSING ” Practice Location

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