Provider Demographics
NPI:1205527850
Name:HOMEOSTASIS HAVEN
Entity type:Organization
Organization Name:HOMEOSTASIS HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP,PMH, MSN, RN
Authorized Official - Phone:443-488-3645
Mailing Address - Street 1:1925 HILLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-3620
Mailing Address - Country:US
Mailing Address - Phone:443-488-3645
Mailing Address - Fax:
Practice Address - Street 1:7501 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-3870
Practice Address - Country:US
Practice Address - Phone:443-488-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty