N/a | |
111 Warren Rd Ste 10a Cockeysville MD 21030-2452 | |
(443) 345-0356 | |
Not Available |
Full Name | N/a |
---|---|
Speciality | Clinic/Center |
Location | 111 Warren Rd Ste 10a, Cockeysville, Maryland |
Authorized Official Name and Position | Evangeline Okechukwu (CEO) |
Authorized Official Contact | 4433450356 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
N/a 111 Warren Rd Ste 10a Cockeysville MD 21030-2452 Ph: (443) 345-0356 | N/a 111 Warren Rd Ste 10a Cockeysville MD 21030-2452 Ph: (443) 345-0356 |
NPI Number | 1821770736 |
---|---|
Provider Enumeration Date | 08/01/2023 |
Last Update Date | 10/07/2023 |
Certification Date | 10/07/2023 |
Medicare PECOS PAC ID | 9739539065 |
---|---|
Medicare Enrollment ID | O20231228001078 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821770736 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Provider Name | Evangeline Uju Okechukwu |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972200624 PECOS PAC ID: 0648620971 Enrollment ID: I20231228001375 |
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