| Temah Healthcare Services, Llc | |
|
5310 Old Court Rd Ste 303 Randallstown MD 21133-6202 | |
| (410) 521-8000 | |
| (410) 655-5826 |
| Full Name | Temah Healthcare Services, Llc |
|---|---|
| Speciality | Home Health |
| Location | 5310 Old Court Rd Ste 303, Randallstown, Maryland |
| Authorized Official Name and Position | Gbenga Williams (ADMINISTRATOR) |
| Authorized Official Contact | 4105218000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Temah Healthcare Services, Llc 5310 Old Court Rd Ste 303 Randallstown MD 21133-6202 Ph: (410) 702-5397 | Temah Healthcare Services, Llc 5310 Old Court Rd Ste 303 Randallstown MD 21133-6202 Ph: (410) 521-8000 |
| NPI Number | 1932523008 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 09/23/2019 |
| Medicare PECOS PAC ID | 6204147077 |
|---|---|
| Medicare Enrollment ID | O20150619001472 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932523008 | NPI | - | NPPES |
| 235326100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251E00000X | Home Health | R3573 (Maryland) | Primary |
| Provider Name | Temitope Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972802890 PECOS PAC ID: 4082880836 Enrollment ID: I20111229000379 |
| Provider Name | Laurene M Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265890065 PECOS PAC ID: 2961707153 Enrollment ID: I20160225002292 |
| Provider Name | Diana Pieterson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558930073 PECOS PAC ID: 5698173243 Enrollment ID: I20211012001475 |
| Provider Name | Emerald Jenkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609659952 PECOS PAC ID: 7618324732 Enrollment ID: I20231113000129 |
| Provider Name | Mercy Maxine Kanno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134838006 PECOS PAC ID: 5496291114 Enrollment ID: I20240718001201 |
| Provider Name | Mary Olabisi Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134755689 PECOS PAC ID: 0941738116 Enrollment ID: I20250115003284 |
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