Provider Demographics
NPI:1841013877
Name:CORERIDGE HEALTH INC
Entity type:Organization
Organization Name:CORERIDGE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GBEMISOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-538-3964
Mailing Address - Street 1:10807 FALLS RD UNIT 255
Mailing Address - Street 2:
Mailing Address - City:BROOKLANDVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21022-7511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:843 CRYSTAL PALACE CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2257
Practice Address - Country:US
Practice Address - Phone:443-538-3964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities