Healthcare Provider Details

I. General information

NPI: 1558073668
Provider Name (Legal Business Name): JK HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 S HANOVER ST
BALTIMORE MD
21225-1705
US

IV. Provider business mailing address

3620 S HANOVER ST
BALTIMORE MD
21225-1705
US

V. Phone/Fax

Practice location:
  • Phone: 410-354-2200
  • Fax:
Mailing address:
  • Phone: 443-769-0897
  • 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 Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: OLANINKAN OLASEHA
Title or Position: CEO
Credential:
Phone: 443-579-6044