Provider Demographics
NPI:1932523008
Name:TEMAH HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:TEMAH HEALTHCARE SERVICES, LLC
Other - Org Name:TEMAH FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GBENGA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-521-8000
Mailing Address - Street 1:5310 OLD COURT RD STE 303
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-6202
Mailing Address - Country:US
Mailing Address - Phone:410-702-5397
Mailing Address - Fax:410-655-5826
Practice Address - Street 1:5310 OLD COURT RD STE 303
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-6202
Practice Address - Country:US
Practice Address - Phone:410-521-8000
Practice Address - Fax:410-655-5826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMAH HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-10
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3573251E00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD235326100Medicaid
MD416163Medicare PIN