Healthcare Provider Details

I. General information

NPI: 1386250660
Provider Name (Legal Business Name): GILGAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 EAST DR STE H
ARBUTUS MD
21227-2403
US

IV. Provider business mailing address

5205 EAST DR STE H
ARBUTUS MD
21227-2403
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-0423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HELEN KUMOLALO
Title or Position: CRNP
Credential:
Phone: 443-631-4318