| Omni House Behavioral Health System | |
|
1419 Madison Park Dr Glen Burnie MD 21061-5613 | |
| (410) 768-2719 | |
| Not Available |
| Full Name | Omni House Behavioral Health System |
|---|---|
| Speciality | Clinic/Center |
| Location | 1419 Madison Park Dr, Glen Burnie, Maryland |
| Authorized Official Name and Position | John Cuddy (CFO) |
| Authorized Official Contact | 4107686777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Omni House Behavioral Health System Po Box 1270 1419 Madison Park Dr Glen Burnie MD 21060-1270 Ph: (410) 768-2719 | Omni House Behavioral Health System 1419 Madison Park Dr Glen Burnie MD 21061-5613 Ph: (410) 768-2719 |
| NPI Number | 1104983568 |
|---|---|
| Provider Enumeration Date | 01/03/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6800840331 |
|---|---|
| Medicare Enrollment ID | O20050308001111 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104983568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 4233 (Maryland) | Primary |
| Provider Name | Sonny M Miranda |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407815913 PECOS PAC ID: 0547214934 Enrollment ID: I20050309000178 |
| Provider Name | Robert Maman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659368538 PECOS PAC ID: 9739166604 Enrollment ID: I20050323000841 |
| Provider Name | Rhoda B Padow |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336163831 PECOS PAC ID: 2163520156 Enrollment ID: I20070614000694 |
| Provider Name | Muhammad A Abbas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801898168 PECOS PAC ID: 8325009202 Enrollment ID: I20081204000291 |
| Provider Name | Nadia Swanson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902093925 PECOS PAC ID: 2860540754 Enrollment ID: I20110510000767 |
| Provider Name | Nneka Obianuju Ezunagu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902230253 PECOS PAC ID: 5092949032 Enrollment ID: I20131008000071 |
| Provider Name | Timothy W Griffith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992185250 PECOS PAC ID: 3375842917 Enrollment ID: I20160503000668 |
| Provider Name | Francine C Schwartz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780857326 PECOS PAC ID: 9032340252 Enrollment ID: I20170823002007 |
| Provider Name | Kara B Iacovella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215599063 PECOS PAC ID: 4385078567 Enrollment ID: I20191220001623 |
| Provider Name | Francine Mefeussom Kamhoua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275145468 PECOS PAC ID: 0042630782 Enrollment ID: I20201019000188 |
| Provider Name | Modupe Adekunle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356926455 PECOS PAC ID: 4183024318 Enrollment ID: I20210610000003 |
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