Provider Demographics
NPI:1205391331
Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Other - Org Name:CIHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBIRONKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-3667
Mailing Address - Street 1:12 CLEMATIS CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5032
Mailing Address - Country:US
Mailing Address - Phone:443-929-3667
Mailing Address - Fax:
Practice Address - Street 1:302 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5312
Practice Address - Country:US
Practice Address - Phone:410-505-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-03
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD390014200Medicaid