Provider Demographics
NPI:1558073668
Name:JK HEALTH SYSTEMS LLC
Entity Type:Organization
Organization Name:JK HEALTH SYSTEMS LLC
Other - Org Name:
Other - Org Type:
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:443-769-0897
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:410-354-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1508520602Medicaid
MD1619430550Medicaid