MEDICARE: KAYSALEM GLOBAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1205795218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYSALEM GLOBAL LLC

Provider Business Mailing Address
First Line	:	10714 HEATHER GLEN WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4296
Country	:	US
Telephone Number	:	301-458-9688
Fax Number	:

Provider Business Practice Location Address
First Line	:	10714 HEATHER GLEN WAY
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-4296
Country	:	US
Telephone Number	:	301-458-9688
Fax Number	:

Authorized Official
Title or Position	:	OPERATION DIRECTOR
Name	:	JOHN OLUSOJI
Credential	:	MD
Telephone Number	:	301-458-9688

Provider Enumeration Date	:	01/16/2026
Last Update Date	:	01/16/2026

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