Provider Demographics
NPI:1811590631
Name:EROSUN BEHAVIORAL HEALTH SERVICES INC,
Entity type:Organization
Organization Name:EROSUN BEHAVIORAL HEALTH SERVICES INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADUNNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-296-4641
Mailing Address - Street 1:10811 RED RUN BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5151
Mailing Address - Country:US
Mailing Address - Phone:410-296-4641
Mailing Address - Fax:
Practice Address - Street 1:10811 RED RUN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5150
Practice Address - Country:US
Practice Address - Phone:410-296-4641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)