Provider Demographics
NPI:1346827250
Name:MMBR BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MMBR BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:MMBR INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLAKUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-438-3457
Mailing Address - Street 1:3804 S. HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:443-438-3457
Mailing Address - Fax:
Practice Address - Street 1:3804 S.HANOVER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:443-438-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3016555086Medicaid