Provider Demographics
NPI:1770298960
Name:ESSENCE HEALTH SUPPORT SERVICES INC.
Entity type:Organization
Organization Name:ESSENCE HEALTH SUPPORT SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHODEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-629-9328
Mailing Address - Street 1:5103 MINTZ LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6864
Mailing Address - Country:US
Mailing Address - Phone:443-413-9621
Mailing Address - Fax:
Practice Address - Street 1:33 W FRANKLIN ST STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4863
Practice Address - Country:US
Practice Address - Phone:443-413-9621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities