Provider Demographics
NPI:1275070633
Name:PREVAIL HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:PREVAIL HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:EGIEFAMEH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:443-630-1567
Mailing Address - Street 1:7515 ROSSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3741
Mailing Address - Country:US
Mailing Address - Phone:443-630-1567
Mailing Address - Fax:
Practice Address - Street 1:8641 LOCH RAVEN BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2311
Practice Address - Country:US
Practice Address - Phone:410-513-7750
Practice Address - Fax:410-513-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3996251E00000X
261QM0801X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No251E00000XAgenciesHome Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty