Healthcare Provider Details

I. General information

NPI: 1639851645
Provider Name (Legal Business Name): BISAK HEALTHCARE SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
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: 443-430-3333
  • Fax:
Mailing address:
  • Phone: 443-430-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: FLORENCE AKANBI
Title or Position: CEO
Credential: CRNP-PMH
Phone: 443-321-3996