Provider Demographics
NPI:1073292330
Name:HIS KEEP SAKE, INC
Entity Type:Organization
Organization Name:HIS KEEP SAKE, INC
Other - Org Name:THE AGAPE WAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:443-473-5080
Mailing Address - Street 1:205 ERIN WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3469
Mailing Address - Country:US
Mailing Address - Phone:443-473-5080
Mailing Address - Fax:
Practice Address - Street 1:6340 SECURITY BLVD STE 100, A3, A15, A17, A45, A46
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5284
Practice Address - Country:US
Practice Address - Phone:443-473-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIS KEEP SAKE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder