Provider Demographics
NPI:1891511861
Name:HOPE HAVEN HEALTHCARE
Entity type:Organization
Organization Name:HOPE HAVEN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWATOYIN
Authorized Official - Middle Name:OMONIYI
Authorized Official - Last Name:OLALEYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:443-616-6802
Mailing Address - Street 1:9602 MAXWELL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3792
Mailing Address - Country:US
Mailing Address - Phone:443-616-6802
Mailing Address - Fax:
Practice Address - Street 1:1314 S BAYLIS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5206
Practice Address - Country:US
Practice Address - Phone:443-290-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone