Provider Demographics
NPI:1518535368
Name:PRIMEHEALTH BEHAVIORAL HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PRIMEHEALTH BEHAVIORAL HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF THE ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:E
Authorized Official - Last Name:IKEJIOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:443-869-2550
Mailing Address - Street 1:3711 STONEYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4134
Mailing Address - Country:US
Mailing Address - Phone:443-869-2550
Mailing Address - Fax:443-869-2750
Practice Address - Street 1:1501 SULGRAVE AVE
Practice Address - Street 2:STE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3651
Practice Address - Country:US
Practice Address - Phone:443-869-2550
Practice Address - Fax:443-869-2750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty