Provider Demographics
NPI:1760165088
Name:REHOBOTH HEALTHCARE AND BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:REHOBOTH HEALTHCARE AND BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NJIDEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMENYI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC, FNP-C
Authorized Official - Phone:443-821-0717
Mailing Address - Street 1:735 BLUE MOON LN
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-7059
Mailing Address - Country:US
Mailing Address - Phone:443-821-0717
Mailing Address - Fax:443-821-0720
Practice Address - Street 1:735 BLUE MOON LN
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7059
Practice Address - Country:US
Practice Address - Phone:443-821-0717
Practice Address - Fax:443-821-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty