Provider Demographics
NPI:1053813535
Name:UNLIMITED BOUNDS HUMAN SERVICES LLC
Entity Type:Organization
Organization Name:UNLIMITED BOUNDS HUMAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARKIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-449-5135
Mailing Address - Street 1:1109 DULANEY GATE CIR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3012
Mailing Address - Country:US
Mailing Address - Phone:443-764-9551
Mailing Address - Fax:
Practice Address - Street 1:4200 PENNINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21226-1324
Practice Address - Country:US
Practice Address - Phone:443-449-5135
Practice Address - Fax:443-449-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BH000313261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH000313Medicaid