Provider Demographics
NPI:1528558210
Name:JR HEALTHCARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JR HEALTHCARE ASSOCIATES, LLC
Other - Org Name:BEHAVIORAL HEALTH CLINIC (BHC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QA/PI CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:LONETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-500-1310
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 1:700 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2350
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:2018-05-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMH000831261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH000830OtherMARYLAND DEPARTMENT OF HEALTH