Provider Demographics
NPI:1659936847
Name:MERIDIAN HEALTH AND BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:MERIDIAN HEALTH AND BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EVA
Authorized Official - Middle Name:K
Authorized Official - Last Name:OGBUOKIRI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-872-5902
Mailing Address - Street 1:6801 KENILWORTH AVE STE 300-S2
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1331
Mailing Address - Country:US
Mailing Address - Phone:240-687-2892
Mailing Address - Fax:
Practice Address - Street 1:6801 KENILWORTH AVE STE 300-S2
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1331
Practice Address - Country:US
Practice Address - Phone:240-687-2892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-03
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty