Provider Demographics
NPI:1780495002
Name:MARYLAND RECOVERY HOMES LLC
Entity type:Organization
Organization Name:MARYLAND RECOVERY HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:JANESTA
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-215-2619
Mailing Address - Street 1:3812 CHESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-1509
Mailing Address - Country:US
Mailing Address - Phone:410-215-2619
Mailing Address - Fax:
Practice Address - Street 1:3812 CHESLEY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-1509
Practice Address - Country:US
Practice Address - Phone:410-215-2619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1000142723Medicaid
MD1000051637Medicaid
MD1000051629Medicaid
MD1000054548Medicaid