Provider Demographics
NPI:1689042541
Name:JR HEALTH CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JR HEALTH CARE ASSOCIATES, LLC
Other - Org Name:BEHAVIORAL HEALTH CLININC (BHC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NAG
Authorized Official - Middle Name:
Authorized Official - Last Name:NELLURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-995-4113
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:
Practice Address - Street 1:2310 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5127
Practice Address - Country:US
Practice Address - Phone:410-844-4110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905861251S00000X, 261QH0100X, 261QR0405X
MDMH-1846261QM0801X, 261QM0850X, 261QM0855X
MDMH-1962261QR0400X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1689042541OtherNPI NUMBER #
MD4239041-00Medicaid
MD4233417-00Medicaid
MD1053719575OtherNPI NUMBER