| Primehealth Behavioral Healthcare Services Llc | |
|
1501 Sulgrave Ave Ste 301 Baltimore MD 21209-3651 | |
| (443) 869-2550 | |
| (443) 869-2750 |
| Full Name | Primehealth Behavioral Healthcare Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1501 Sulgrave Ave, Baltimore, Maryland |
| Authorized Official Name and Position | Moses E Ikejiofor (OWNER OF THE ENTITY) |
| Authorized Official Contact | 4438692550 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primehealth Behavioral Healthcare Services Llc 3711 Stoneybrook Rd Randallstown MD 21133-4134 Ph: (443) 869-2550 | Primehealth Behavioral Healthcare Services Llc 1501 Sulgrave Ave Ste 301 Baltimore MD 21209-3651 Ph: (443) 869-2550 |
| NPI Number | 1518535368 |
|---|---|
| Provider Enumeration Date | 06/16/2021 |
| Last Update Date | 03/17/2023 |
| Certification Date | 03/17/2023 |
| Medicare PECOS PAC ID | 0042683393 |
|---|---|
| Medicare Enrollment ID | O20230502000950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518535368 | NPI | - | NPPES |
| Provider Name | Moses Ekemezie Ikejiofor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437704103 PECOS PAC ID: 6800224601 Enrollment ID: I20200310000012 |
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