| Kemoda Behavioral Health Llc | |
|
1515 Martin Blvd Ste 201 Middle River MD 21220-4103 | |
| (410) 929-3846 | |
| Not Available |
| Full Name | Kemoda Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1515 Martin Blvd Ste 201, Middle River, Maryland |
| Authorized Official Name and Position | Veronica Oge (PRESIDENT) |
| Authorized Official Contact | 4432248301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kemoda Behavioral Health Llc 1515 Martin Blvd Ste 201 Middle River MD 21220-4103 Ph: (410) 929-3846 | Kemoda Behavioral Health Llc 1515 Martin Blvd Ste 201 Middle River MD 21220-4103 Ph: (410) 929-3846 |
| NPI Number | 1083433411 |
|---|---|
| Provider Enumeration Date | 10/03/2024 |
| Last Update Date | 12/09/2024 |
| Certification Date | 12/09/2024 |
| Medicare PECOS PAC ID | 7810429420 |
|---|---|
| Medicare Enrollment ID | O20241021000478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083433411 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Veronica Modupe Oge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801591078 PECOS PAC ID: 4981052164 Enrollment ID: I20231129000009 |
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