Healthcare Provider Details

I. General information

NPI: 1356937080
Provider Name (Legal Business Name): EXCELLENT HEALTHCARE & PSYCHIATRIC REHABILITATION PROGRAM SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 W BELVEDERE AVE UNIT A
BALTIMORE MD
21215-5502
US

IV. Provider business mailing address

4002 W BELVEDERE AVE UNIT A
BALTIMORE MD
21215-5502
US

V. Phone/Fax

Practice location:
  • Phone: 410-984-7411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. INNOCENT AKPUAKA
Title or Position: PRESIDENT
Credential: RN
Phone: 410-984-7411