Provider Demographics
NPI:1689078057
Name:AUDACITY OF HOPE BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AUDACITY OF HOPE BEHAVIORAL HEALTH LLC
Other - Org Name:AUDACITY OF HOPE BEHAVIORAL HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RENARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-246-0600
Mailing Address - Street 1:2211 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3529
Mailing Address - Country:US
Mailing Address - Phone:410-246-0600
Mailing Address - Fax:
Practice Address - Street 1:2211 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5627
Practice Address - Country:US
Practice Address - Phone:410-246-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization