Healthcare Provider Details

I. General information

NPI: 1619656477
Provider Name (Legal Business Name): BISAK HEALTHCARE SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E LEXINGTON ST STE 601
BALTIMORE MD
21202-3529
US

IV. Provider business mailing address

218 E LEXINGTON ST STE 601
BALTIMORE MD
21202-3529
US

V. Phone/Fax

Practice location:
  • Phone: 443-858-4111
  • Fax:
Mailing address:
  • Phone: 443-858-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FLORENCE AKANBI
Title or Position: CEO
Credential: PMHNP
Phone: 443-231-3996