Organization Active NPI

Hebron House, Inc.

  • Community/Behavioral Health Agency
  • Baltimore, MD
National Provider Identifier
1699837526
Registry record updated Dec 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
HEBRON HOUSE, INC.
Practice address
2300 Garrison Blvd Ste 101
Baltimore, MD 21216-2308
Phone
(410) 233-1990
Fax
(410) 233-1991
NPI assigned
Dec 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2017

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

Authorized official

Name
Mr. Matanmi Olusesan Kuforiji, LCSW-C
Title
Program Director
Phone
(410) 233-1990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2300 Garrison Blvd Ste 101
Baltimore, MD 21216-2308

Mailing address

2300 Garrison Blvd Ste 101
Baltimore, MD 21216-2308
Phone (410) 233-1990

Other identifiers 1

IdentifierTypeStateIssuer
403-43-2500MedicaidMD

National Provider Directory

National Provider Directory

Locations

2300 Garrison Blvd
Ste 101
Baltimore, MD 21216
Phone (410) 233-1990

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": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1699837526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 GARRISON BLVD STE 101",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212162308",
            "telephone_number": "410-233-1990",
            "fax_number": "410-233-1991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 GARRISON BLVD STE 101",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212162308",
            "telephone_number": "410-233-1990",
            "fax_number": "410-233-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEBRON HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "KUFORIJI",
        "authorized_official_first_name": "MATANMI",
        "authorized_official_middle_name": "OLUSESAN",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "410-233-1990",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW-C"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403-43-2500",
            "state": "MD"
        }
    ],
    "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 Dec 27, 2017; 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.