Provider Demographics
NPI:1831859990
Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:COMMUNITY INTERVENTION HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBIRONKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-3667
Mailing Address - Street 1:302 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5312
Mailing Address - Country:US
Mailing Address - Phone:443-929-3667
Mailing Address - Fax:
Practice Address - Street 1:302 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5312
Practice Address - Country:US
Practice Address - Phone:410-929-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health