Provider Demographics
NPI:1487387619
Name:HUMBLE BEGINNINGS RECOVERY LLC
Entity type:Organization
Organization Name:HUMBLE BEGINNINGS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C, LCADC
Authorized Official - Phone:443-971-1451
Mailing Address - Street 1:1103 WALNUT WOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-5403
Mailing Address - Country:US
Mailing Address - Phone:443-971-1451
Mailing Address - Fax:
Practice Address - Street 1:4515 BOWLEYS LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-6641
Practice Address - Country:US
Practice Address - Phone:443-707-5558
Practice Address - Fax:833-301-1994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMBLE BEGINNINGS RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1588246995Medicaid