Provider Demographics
NPI:1285124339
Name:JR HEALTHCARE ASSOCIATES LLC DBA. BEHAVIORAL HEALTH CLINIC (BHC)
Entity type:Organization
Organization Name:JR HEALTHCARE ASSOCIATES LLC DBA. BEHAVIORAL HEALTH CLINIC (BHC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAG
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-995-4113
Mailing Address - Street 1:2310 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5127
Mailing Address - Country:US
Mailing Address - Phone:410-844-4110
Mailing Address - Fax:410-741-3008
Practice Address - Street 1:2310 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5127
Practice Address - Country:US
Practice Address - Phone:410-844-4110
Practice Address - Fax:410-741-3008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH-1846251S00000X
MDMH-1962261QM0801X
MD905861261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9000089-00Medicaid
MD4233417-00Medicaid
MD4239041-00Medicaid