Provider Demographics
NPI:1245726462
Name:BEACON OF HOPE WELLNESS CENTER
Entity type:Organization
Organization Name:BEACON OF HOPE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-685-2830
Mailing Address - Street 1:828 GUILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3707
Mailing Address - Country:US
Mailing Address - Phone:410-685-2830
Mailing Address - Fax:
Practice Address - Street 1:828 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3707
Practice Address - Country:US
Practice Address - Phone:410-685-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE MERCY, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)