Healthcare Provider Details

I. General information

NPI: 1316989908
Provider Name (Legal Business Name): JOHMAB FAMILY PRESERVATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 DRUID PARK DR SUITE 300
BALTIMORE MD
21215-8102
US

IV. Provider business mailing address

2901 DRUID PARK DR SUITE 300
BALTIMORE MD
21215-8102
US

V. Phone/Fax

Practice location:
  • Phone: 410-523-2100
  • Fax: 410-523-1211
Mailing address:
  • Phone: 410-523-2100
  • Fax: 410-523-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number9642
License Number StateMD

VIII. Authorized Official

Name: MR. EMMANUEL O. IROANYA
Title or Position: DIRECTOR
Credential: MSW
Phone: 410-523-2100