PORT RECOVERY MENTAL HEALTH, INC. (NPI# 1902375090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902375090 |
| Entity Type | Organization |
| Organization Name | PORT RECOVERY MENTAL HEALTH, INC. |
| Practice Address |
8615 Ridgelys Choice Dr Ste 205 Nottingham MD 21236-3028 |
| Practice Telephone | 4438694909 |
| Practice Fax Number | 4438694928 |
| Mailing Telephone | 4105348735 |
| Mailing Fax Number | 4105348737 |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2018-11-19 |
| Authorized Official Name | JOANNE GRANRUTH (OWNER) |
| Authorized Official Telephone | 4105348735 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932453727 | Port Recovery Mental Health, Inc. | Counselor | 7004 Harford Rd, Baltimore, MD 21234-7704 | 2012-11-01 |
| Street Address |
8615 RIDGELYS CHOICE DR STE 205 |
| City | NOTTINGHAM |
| State | MD |
| Zip Code | 21236-3028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366876690 | Carol Garey | Social Worker | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2013-08-22 |
| 1649733858 | Port Recovery Iop Inc. | Clinical Medical Laboratory | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-04-14 |
| 1578026464 | Port Recovery Iop Inc. | Counselor | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-04-09 |
| 1528522901 | Port Recovery Iop Inc. | Clinic/Center | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2019-01-30 |
| 1598234601 | Port Recovery Iop Inc. | Counselor | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2018-11-19 |
| 1124470356 | Port Recovery Physicians Care LLC | Internal Medicine | 8615 Ridgelys Choice Dr Ste 205, Nottingham, MD 21236-3028 | 2016-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699381467 | Monique Gaston | Counselor | Well Life Counseling and Consulting, 9649 Belair Road, Ste. 104, Nottingham, MD 21236 | 2020-09-17 |
| 1215575519 | Bh Brightview Perry Hall Opco, LLC | Alzheimer Center (Dementia Center) | 9657 Belair Road, Nottingham, MD 21236 | 2019-12-17 |
| 1750929493 | Bh Brightview White Marsh Opco, LLC | Alzheimer Center (Dementia Center) | 8100 Rossville Blvd., Baltimore, MD 21236 | 2019-12-12 |
| 1083257646 | Matthew Peter Halstad | Behavioral Analyst | 8090 Sandpiper Circle, Nottingham, MD 21236 | 2019-10-25 |
| 1609331602 | Tunisia Buise | Social Worker | 4132 E. Joppa Road Ste. 110-#1248, Baltimore, MD 21236 | 2019-02-04 |
| 1730673047 | Golden Jemz Adult Medical Day | Clinic/Center | 5020 Cambell Blvd, Nottingham, MD 21236 | 2018-06-20 |
| 1487143400 | For Eyes Optical of Pa | Eyewear Supplier (Equipment, not the service) | 7984 Honeygo Blvd, Nottingham, MD 21236 | 2018-05-04 |
| 1619478922 | Weis Markets, Inc. | Pharmacy | 7927 Belair Rd Ste S, Nottingham, MD 21236 | 2018-02-22 |
| 1285133918 | Joan Rosa Keller | Behavior Technician | 3501 Taylor Ave., Baltimore, MD 21236 | 2018-02-08 |
| 1205341146 | Ebony Watkins | Nurse Practitioner | 8940 Kilkenny Circle, Nottingham, MD 21236 | 2017-12-13 |
| Find all providers in zip 21236 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861981276 | Harmony Counceling Center Inc | Counselor | 7939 Honeygo Blvd Ste 224, Nottingham, MD 21236-5992 | 2018-05-02 |
| 1760994560 | Monique Desiree Rodriguez | Counselor | 5022 Campbell Blvd, Nottingham, MD 21236-4969 | 2017-11-02 |
| 1316221955 | Jessica S Hayden | Counselor | 9534 Belair Rd, Nottingham, MD 21236-1508 | 2011-09-30 |
| 1952617052 | Heidi Ann Scott | Counselor | 122 Canterbury Ct, Nottingham, PA 19362-9054 | 2010-08-26 |
| 1306445176 | Saba Bader | Counselor | 5022 Campbell Blvd Ste L, Nottingham, MD 21236-4969 | 2020-10-22 |
| 1669070082 | Lauren A Stevens | Counselor | 7658 Belair Rd, Nottingham, MD 21236-4020 | 2020-10-16 |
| 1821601519 | Madeline Leffler | Counselor | 5022 Campbell Blvd Ste L, Nottingham, MD 21236-4969 | 2020-08-24 |
| 1922616655 | Jillian Lansey | Counselor | 5022 Campbell Blvd Ste L, Nottingham, MD 21236-4969 | 2020-07-20 |
| 1447886072 | Emily Stanley | Counselor | 5022 Campbell Blvd Ste L-m, Nottingham, MD 21236-4969 | 2020-03-16 |
| 1972135275 | Brenda B. Wilson | Counselor | 5022 Campbell Blvd Ste L, Nottingham, MD 21236-4969 | 2020-02-05 |
| Find all providers in NOTTINGHAM | ||||
| City | NOTTINGHAM |
| Zip Code | 21236 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.