| Maryland Mental Healthcare Limited Liability Company | |
|
4155 Glen Park Rd Nottingham MD 21236-1019 | |
| (410) 248-0661 | |
| Not Available |
| Full Name | Maryland Mental Healthcare Limited Liability Company |
|---|---|
| Speciality | Clinic/Center |
| Location | 4155 Glen Park Rd, Nottingham, Maryland |
| Authorized Official Name and Position | Minnie Tampus (OWNER) |
| Authorized Official Contact | 4439301341 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maryland Mental Healthcare Limited Liability Company 216 Oak Valley Dr Bel Air MD 21014-5941 Ph: (443) 930-1341 | Maryland Mental Healthcare Limited Liability Company 4155 Glen Park Rd Nottingham MD 21236-1019 Ph: (410) 248-0661 |
| NPI Number | 1437917812 |
|---|---|
| Provider Enumeration Date | 03/11/2024 |
| Last Update Date | 03/11/2024 |
| Certification Date | 03/11/2024 |
| Medicare PECOS PAC ID | 8022450089 |
|---|---|
| Medicare Enrollment ID | O20240522004270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437917812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Yetunde Adegoroye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245884733 PECOS PAC ID: 0749511673 Enrollment ID: I20191008001539 |
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