Provider Demographics
NPI:1245811009
Name:TARGET BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:TARGET BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANIMODO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:410-888-7143
Mailing Address - Street 1:1415 MOONSHADOW RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4999
Mailing Address - Country:US
Mailing Address - Phone:410-888-7143
Mailing Address - Fax:410-888-7145
Practice Address - Street 1:15 E CHURCHVILLE RD STE 106
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3837
Practice Address - Country:US
Practice Address - Phone:410-888-7143
Practice Address - Fax:410-888-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)