Provider Demographics
NPI:1992396568
Name:VILLAGE BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:VILLAGE BEHAVIORAL HEALTH CENTER
Other - Org Name:VILLAGE BEHAVIORAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUWAFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AFOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:667-225-0081
Mailing Address - Street 1:5718 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2603
Mailing Address - Country:US
Mailing Address - Phone:667-225-0081
Mailing Address - Fax:
Practice Address - Street 1:5718 BELAIR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2603
Practice Address - Country:US
Practice Address - Phone:667-225-0081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty