| Prime Behavioral Health Llc | |
|
13994 Baltimore Ave Ste 102 Laurel MD 20707-5087 | |
| (240) 463-3357 | |
| Not Available |
| Full Name | Prime Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13994 Baltimore Ave Ste 102, Laurel, Maryland |
| Authorized Official Name and Position | Julius Fomengia (PARTNER) |
| Authorized Official Contact | 2404633357 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prime Behavioral Health Llc 13994 Baltimore Ave Ste 102 Laurel MD 20707-5087 Ph: () - | Prime Behavioral Health Llc 13994 Baltimore Ave Ste 102 Laurel MD 20707-5087 Ph: (240) 463-3357 |
| NPI Number | 1164990818 |
|---|---|
| Provider Enumeration Date | 11/10/2018 |
| Last Update Date | 11/10/2018 |
| Medicare PECOS PAC ID | 7214277839 |
|---|---|
| Medicare Enrollment ID | O20190319000559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164990818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Yvonne Etenyi Fomengia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215286810 PECOS PAC ID: 0840449872 Enrollment ID: I20121005000452 |
| Provider Name | Charles Besong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720432172 PECOS PAC ID: 3870882533 Enrollment ID: I20160519000726 |
| Provider Name | Ernestine M Enohmbi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154726404 PECOS PAC ID: 1951680719 Enrollment ID: I20161118000060 |
| Provider Name | Julius Fomengia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538688684 PECOS PAC ID: 7416216965 Enrollment ID: I20180110000660 |
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