Healthcare Provider Details

I. General information

NPI: 1952284044
Provider Name (Legal Business Name): BALM OF GILEAD HEALTH & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 BELAIR RD
BALTIMORE MD
21206-4208
US

IV. Provider business mailing address

5440 BELAIR RD
BALTIMORE MD
21206-4208
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7405
  • Fax:
Mailing address:
  • Phone: 443-868-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHINWE M OKUDO
Title or Position: MEDICAL DIRECTOR
Credential: DNP
Phone: 443-868-7405