Provider Demographics
NPI:1710644760
Name:ITOJU HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:ITOJU HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAMOYEGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-505-0419
Mailing Address - Street 1:145 W OSTEND ST STE 600
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3774
Mailing Address - Country:US
Mailing Address - Phone:443-960-1030
Mailing Address - Fax:
Practice Address - Street 1:145 W OSTEND ST STE 600
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3774
Practice Address - Country:US
Practice Address - Phone:443-960-1030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)