Healthcare Provider Details

I. General information

NPI: 1558253153
Provider Name (Legal Business Name): PEACEFUL BEHAVIORAL HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5884 BELAIR RD
BALTIMORE MD
21206-2612
US

IV. Provider business mailing address

5884 BELAIR RD
BALTIMORE MD
21206-2612
US

V. Phone/Fax

Practice location:
  • Phone: 443-791-0678
  • 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 Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELECHI AGUGUO
Title or Position: CEO
Credential:
Phone: 443-791-0678