Provider Demographics
NPI:1508520602
Name:JK HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:JK HEALTH SYSTEM LLC
Other - Org Name:JK HEALTH SYSTEMS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLANINKAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLASEHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-579-6044
Mailing Address - Street 1:3620 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-1705
Mailing Address - Country:US
Mailing Address - Phone:443-579-6044
Mailing Address - Fax:
Practice Address - Street 1:3620 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1705
Practice Address - Country:US
Practice Address - Phone:443-579-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)