MEDICARE: REY OF HOPE PHASE PROGRAM, LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1578258760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REY OF HOPE PHASE PROGRAM, LLC

Provider Business Mailing Address
First Line	:	1502 E JOPPA RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-5911
Country	:	US
Telephone Number	:	443-673-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 KENNEDY AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-6307
Country	:	US
Telephone Number	:	443-845-4969
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JACQUELINE D MARION
Credential	:
Telephone Number	:	443-673-8025

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	09/11/2025

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