Provider Demographics
NPI:1649203662
Name:NATIONAL PIKE HEALTH CENTER, INC
Entity Type:Organization
Organization Name:NATIONAL PIKE HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:OLUDARE
Authorized Official - Last Name:OWOYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-744-8100
Mailing Address - Street 1:5411 OLD FREDERICK RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2195
Mailing Address - Country:US
Mailing Address - Phone:410-744-8100
Mailing Address - Fax:410-744-2530
Practice Address - Street 1:5411 OLD FREDERICK RD
Practice Address - Street 2:SUITE 13
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2195
Practice Address - Country:US
Practice Address - Phone:410-744-8100
Practice Address - Fax:410-744-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty