MEDICARE: WAY OF HOPE INC.

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902541113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY OF HOPE INC.

Provider Business Mailing Address
First Line	:	7412 RICKSWAY RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21208-5719
Country	:	US
Telephone Number	:	443-794-9094
Fax Number	:	410-486-3793

Provider Business Practice Location Address
First Line	:	3312 W NORTH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21216-3018
Country	:	US
Telephone Number	:	443-623-2449
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MARIE G FERNELIS
Credential	:
Telephone Number	:	443-794-9094

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/03/2022

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Directions to “WAY OF HOPE INC. ” Practice Location

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