Provider Demographics
NPI:1164169991
Name:SALVATION MULTIPURPOSE COMMUNUTY OUTREACH
Entity Type:Organization
Organization Name:SALVATION MULTIPURPOSE COMMUNUTY OUTREACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AYODEJI
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:OLORUNSOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-438-7610
Mailing Address - Street 1:2319 MARYLAND AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5010
Mailing Address - Country:US
Mailing Address - Phone:443-438-7610
Mailing Address - Fax:443-438-7809
Practice Address - Street 1:2319 MARYLAND AVE FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5010
Practice Address - Country:US
Practice Address - Phone:443-438-7610
Practice Address - Fax:443-438-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation