NPIMap

Organization Active NPI

Heavens Place-Outpatient Detox & Recovery Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baltimore, MD
National Provider Identifier
1083286280
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
HEAVENS PLACE-OUTPATIENT DETOX & RECOVERY CENTER
Practice address
11 E Lexington St Ste 300
Baltimore, MD 21202-1720
Phone
(443) 708-5612
Fax
(410) 826-3855
NPI assigned
Jul 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bisrat Mesfin, PMHNP
Title
Ceo
Phone
(443) 708-5612

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

11 E Lexington St Ste 300
Baltimore, MD 21202-1720

Mailing address

11 E Lexington St Ste 300
Baltimore, MD 21202-1720
Phone (443) 708-5612

National Provider Directory

National Provider Directory

Locations

11 E Lexington St
Ste 300
Baltimore, MD 21202
Phone (443) 708-5612

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626307200000",
    "number": "1083286280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 E LEXINGTON ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212021720",
            "telephone_number": "443-708-5612",
            "fax_number": "410-826-3855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 E LEXINGTON ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212021720",
            "telephone_number": "443-708-5612",
            "fax_number": "410-826-3855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEAVENS PLACE-OUTPATIENT DETOX & RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "MESFIN",
        "authorized_official_first_name": "BISRAT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "443-708-5612",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.