| Healthy Lives, Llc | |
|
1001 Pine Heights Ave Ste 303 Baltimore MD 21229-5202 | |
| (443) 219-7901 | |
| (443) 835-2521 |
| Full Name | Healthy Lives, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1001 Pine Heights Ave Ste 303, Baltimore, Maryland |
| Authorized Official Name and Position | Ahmein Watson (CEO) |
| Authorized Official Contact | 4437223116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Lives, Llc 1001 Pine Heights Ave Ste 303 Baltimore MD 21229-5202 Ph: (443) 219-7901 | Healthy Lives, Llc 1001 Pine Heights Ave Ste 303 Baltimore MD 21229-5202 Ph: (443) 219-7901 |
| NPI Number | 1679171052 |
|---|---|
| Provider Enumeration Date | 10/16/2020 |
| Last Update Date | 10/04/2023 |
| Certification Date | 10/04/2023 |
| Medicare PECOS PAC ID | 5193025534 |
|---|---|
| Medicare Enrollment ID | O20151208000085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679171052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Ahmein Watson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588938237 PECOS PAC ID: 6002116449 Enrollment ID: I20151208000124 |
| Provider Name | Cassandra Burks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700546223 PECOS PAC ID: 7810366887 Enrollment ID: I20221214000199 |
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