Provider Demographics
NPI:1497384705
Name:TEMAH HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:TEMAH HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH NURSE PRA
Authorized Official - Prefix:
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, PMH-BC
Authorized Official - Phone:410-521-8000
Mailing Address - Street 1:4320 BROOKSIDE OAKS
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5169
Mailing Address - Country:US
Mailing Address - Phone:410-521-8000
Mailing Address - Fax:410-655-5826
Practice Address - Street 1:5310 OLD COURT RD STE 304
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-6202
Practice Address - Country:US
Practice Address - Phone:410-521-8000
Practice Address - Fax:410-655-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD651406500Medicaid