Provider Demographics
NPI:1841815560
Name:HARVESTING HOPE YOUTH AND FAMILIES SERVICES
Entity type:Organization
Organization Name:HARVESTING HOPE YOUTH AND FAMILIES SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OMEAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:301-728-3857
Mailing Address - Street 1:204 CEDAR ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2395
Mailing Address - Country:US
Mailing Address - Phone:301-728-3857
Mailing Address - Fax:
Practice Address - Street 1:204 CEDAR ST STE 102
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2395
Practice Address - Country:US
Practice Address - Phone:301-728-3857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARVESTING HOPE YOUTH AND FAMILIES SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD072383500Medicaid