Provider Demographics
NPI:1851974885
Name:EMMANUEL HEALTH CARE CENTER L.L.LC.
Entity Type:Organization
Organization Name:EMMANUEL HEALTH CARE CENTER L.L.LC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:TOYOSI
Authorized Official - Last Name:ADERETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-603-0890
Mailing Address - Street 1:9633 LIBERTY RD STE D
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-2435
Mailing Address - Country:US
Mailing Address - Phone:240-603-0890
Mailing Address - Fax:443-272-6766
Practice Address - Street 1:9633 LIBERTY RD STE D
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-2435
Practice Address - Country:US
Practice Address - Phone:240-603-0890
Practice Address - Fax:443-272-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty