Provider Demographics
NPI:1285042283
Name:PITOC-BEHAVIORAL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:PITOC-BEHAVIORAL HEALTH SYSTEMS, LLC
Other - Org Name:PITOC-BEHAVIORAL HEALTH SYSTEMS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PINCIPAL INVESTIGATOR-CEO
Authorized Official - Prefix:
Authorized Official - First Name:OMORUYI
Authorized Official - Middle Name:EPHRAIM K
Authorized Official - Last Name:OKUNDAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C, LCADC
Authorized Official - Phone:443-682-5807
Mailing Address - Street 1:PO BOX 7921
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-0921
Mailing Address - Country:US
Mailing Address - Phone:443-682-5807
Mailing Address - Fax:
Practice Address - Street 1:16 W 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5002
Practice Address - Country:US
Practice Address - Phone:443-682-5807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17618320800000X
MDLCA3693245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness