Provider Demographics
NPI:1992255525
Name:AUDACITY OF HOPE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:AUDACITY OF HOPE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-246-0600
Mailing Address - Street 1:2219 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5627
Mailing Address - Country:US
Mailing Address - Phone:410-246-0600
Mailing Address - Fax:
Practice Address - Street 1:2219 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5627
Practice Address - Country:US
Practice Address - Phone:410-246-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty