Provider Demographics
NPI:1073748588
Name:UMOJA HEALTH SYSTEM, LLC
Entity Type:Organization
Organization Name:UMOJA HEALTH SYSTEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVON
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-204-1134
Mailing Address - Street 1:6564 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-2312
Mailing Address - Country:US
Mailing Address - Phone:443-204-1134
Mailing Address - Fax:
Practice Address - Street 1:6564 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2312
Practice Address - Country:US
Practice Address - Phone:443-204-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY VISIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty