Provider Demographics
NPI:1437735529
Name:GRATITUDE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:GRATITUDE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:RISSOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-924-4513
Mailing Address - Street 1:600 DOVER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3846
Mailing Address - Country:US
Mailing Address - Phone:505-469-1738
Mailing Address - Fax:
Practice Address - Street 1:600 DOVER RD STE 107
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3846
Practice Address - Country:US
Practice Address - Phone:410-924-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder