NPIMap

Organization Active NPI

Port Recovery Mental Health, Inc.

  • Mental Health Counselor
  • Baltimore, MD
National Provider Identifier
1932453727
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
PORT RECOVERY MENTAL HEALTH, INC.
Practice address
7004 Harford Rd
Baltimore, MD 21234-7704
Phone
(443) 869-4909
Fax
(443) 869-4928
NPI assigned
Nov 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Authorized official

Name
Joanne Granruth
Title
Owner
Phone
(443) 534-8735

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

7004 Harford Rd
Baltimore, MD 21234-7704

Mailing address

8615 Ridgelys Choice Dr Ste 205
Nottingham, MD 21236-3028
Phone (410) 534-8735

Other identifiers 1

IdentifierTypeStateIssuer
623601400MedicaidMD

National Provider Directory

National Provider Directory

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": "1351728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1932453727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8615 RIDGELYS CHOICE DR STE 205",
            "city": "NOTTINGHAM",
            "state": "MD",
            "postal_code": "212363028",
            "telephone_number": "410-534-8735",
            "fax_number": "410-534-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7004 HARFORD RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212347704",
            "telephone_number": "443-869-4909",
            "fax_number": "443-869-4928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT RECOVERY MENTAL HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-01",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "GRANRUTH",
        "authorized_official_first_name": "JOANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "443-534-8735"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "623601400",
            "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 Nov 19, 2018; 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.