Healthcare Provider Details

I. General information

NPI: 1114690674
Provider Name (Legal Business Name): BALM OF GILEAD HEALTH & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 BELAIR RD
BALTIMORE MD
21206-4208
US

IV. Provider business mailing address

5440 BELAIR RD
BALTIMORE MD
21206-4208
US

V. Phone/Fax

Practice location:
  • Phone: 443-868-7405
  • Fax: 443-231-7854
Mailing address:
  • Phone: 443-868-7405
  • Fax: 443-231-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. CHINWE M OKUDO
Title or Position: MEDICAL DIRECTOR
Credential: DNP, CRNP
Phone: 443-868-7405