Provider Demographics
NPI:1982315271
Name:MINE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:MINE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OYEKUMLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEYEMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-768-8009
Mailing Address - Street 1:3421 BENSON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1064
Mailing Address - Country:US
Mailing Address - Phone:410-709-1010
Mailing Address - Fax:410-779-9233
Practice Address - Street 1:3421 BENSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1064
Practice Address - Country:US
Practice Address - Phone:410-709-1010
Practice Address - Fax:410-779-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)