Healthcare Provider Details

I. General information

NPI: 1285473991
Provider Name (Legal Business Name): OLYMPUS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 SECURITY BLVD STE 100B40
BALTIMORE MD
21207-5173
US

IV. Provider business mailing address

6340 SECURITY BLVD STE 100B40
BALTIMORE MD
21207-5173
US

V. Phone/Fax

Practice location:
  • Phone: 443-791-7005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. MATHIAS BAMA
Title or Position: CEO
Credential:
Phone: 443-791-7005