Provider Demographics
NPI:1669860151
Name:YOUR HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:YOUR HEALTH NETWORK, INC.
Other - Org Name:EVERGREEN HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOHNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-451-4973
Mailing Address - Street 1:3000 FALLS RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2474
Mailing Address - Country:US
Mailing Address - Phone:443-963-2818
Mailing Address - Fax:
Practice Address - Street 1:733 W 40TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2112
Practice Address - Country:US
Practice Address - Phone:443-451-4993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUR HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5354021Medicaid