Provider Demographics
NPI:1396378006
Name:LA REINE HEALTH CARE SYSTEMS, LLC
Entity type:Organization
Organization Name:LA REINE HEALTH CARE SYSTEMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADENIKE BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR'S DEGREE
Authorized Official - Phone:443-558-6011
Mailing Address - Street 1:6263 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2020
Mailing Address - Country:US
Mailing Address - Phone:443-558-6011
Mailing Address - Fax:443-687-7940
Practice Address - Street 1:6263 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2020
Practice Address - Country:US
Practice Address - Phone:443-558-6011
Practice Address - Fax:443-687-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD442206600Medicaid